| Objective:This study was conducted in our hospital pediatric intensive care unit(referred to as Pediatric ICU,including Neonatal intensive care unit(NICU)and Pediatric intensive care unit(PICU)).The clinical data were analyzed,and the minimum inhibitory concentration and drug resistance of clinical isolates of Klebsiella pneumoniae were analyzed.Combined with clinical data,the extended spectrum ?-lactamases(ESLBs)were further investigated.Risk factors associated with Klebsiella pneumoniae.In addition,this paper will also analyze the drug resistance genes of clinically isolated Klebsiella pneumoniae strains from the molecular biology level,aiming to explore the clinical and drug resistance gene characteristics of Klebsiella pneumoniae infection in children ICU in Ningbo.Relevant evidence for clinical rational drug use and nosocomial infection control.Methods:(1)Retrospective analysis of case information and related clinical data of children with Klebsiella pneumoniae from January 2012 to December 2017 in our children's ICU,and 15 kinds of age,gender,birth weight,laboratory examination,etc.The clinical factors were analyzed by univariate analysis and Logistic regression multivariate analysis to explore the risk factors.(2)Bacterial culture and identification using a VITEK-60 automatic microbiological analyzer.The ESBL-producing strain was confirmed by the paper diffusion method recommended by CLSI in the United States.(3)The minimum inhibitory concentration of ESBLs on 24 antibiotics such as ampicillin was determined by micro-broth dilution method.(4)ESBLs-positive K.pneumoniae was inoculated on MH agar plates for 18-24 hours,and DNA was extracted using the OMEGA Bacterial DNA Kit.(5)Detection of drug resistance genes by polymerase chain reaction(PCR)and analysis.Results:(1)A total of 356 cases of Klebsiella pneumoniae were detected in the ICU of our hospital from 2012 to 2017.The composition ratios of the total strains in each year were 11.8%(37/314)and 16.0%(51/319,respectively).),14.1%(47/333),18.2%(66/362),17.6%(70/398),18.4%(85/462).(2)After removing duplicate strains and colonized strains,263 strains of Klebsiella pneumoniae were detected from 2012 to 2017,mainly from respiratory specimens,and respiratory specimens of ESBLs-producing Klebsiella pneumoniae infection group accounted for 93.5%,sputum Specimens accounted for 86%.(3)The underlying diseases of ESBLs-producing Klebsiella pneumoniae infection group were 41 cases of congenital heart disease,72 cases of anemia,49 cases of respiratory distress and 57 cases of pneumonia.(4)In the infancy,the proportion of ESBLs produced in the age group other than the newborn(28 days-1 year old)was higher.(5)The infection rate of ESBLs-producing Klebsiella pneumoniae infection group in June,July and October was higher than that in other months,which were 18.3%,15.1%,and 10.8%,respectively.(6)8 cases of ESBLs-producing Klebsiella pneumoniae infection group,accounting for 8.6%,71 cases survived,accounting for 76.1%,6 cases were abandoned,accounting for 6.5%,and 8 cases were transferred,accounting for 8.6%.(7)There were 58 males and 35 females in the ESBLs-producing Klebsiella pneumoniae infection group.The number of males in the ESBLsproducing group was 63,accounting for 67.7%.A total of 27 children were hospitalized within half a year,accounting for 29%.(8)Logistic stepwise regression analysis showed that children with gastrointestinal decompression tubes,previous use of third-generation cephalosporins,and anemia were more likely to be infected with ESBLs.(9)Klebsiella pneumoniae has different degrees of resistance to MIC results in 24 antibiotics,and the highest resistance rate to ampicillin,piperacillin and cefazolin,up to 90%;on ampicillin/suba The resistance rate of tannin,aztreonam,ceftriaxone and tetracycline was also >50%;the sensitivity rate for amikacin,tigecycline and nitrofurantoin was 100%.(10)ESBLs Klebsiella pneumoniae amplified a total of 12 drug resistance genes,of which 6 drug resistance genes were detected in different degrees,and the detection rate of drug resistance gene shv was as high as 86.7%.Conclusion:(1)In the past six years,the number of Klebsiella pneumoniae detected in the intensive care unit of our hospital was relatively high,accounting for the first place of all strains,which deserves attention.(2)The infection caused by ESBLs-producing Klebsiella pneumoniae is related to a number of factors.The use of gastrointestinal decompression tube,the use of thirdgeneration cephalosporins before infection,and anemia are independent risk factors.(3)Klebsiella pneumoniae producing ESBLs has serious bacterial resistance in this area,and the multi-drug resistance model is complicated.The need to rationally apply antibiotics,especially the application of third-generation cephalosporins,is of great significance. |
PDF Full Text Request