| BackgroundKlebsiella pneumoniae(KP)is one of the important pathogenic bacteria that cause clinical infection,and is also one of the main pathogenic bacteria of sepsis in children.Children with klebsiella pneumoniae sepsis have a high mortality rate,and with the emergence of plasmid-mediated ultra-broad-spectrum-lactamase(ESBLs),AmpC enzymes and carbapenems enzymes(KPC),antibiotic resistance to Klebsiella pneumoniae rapidly increases,bringing great challenges to clinical treatment.The results of Zhang Hong et al.showed that esBL-producing Klebsiella pneumoniae was mainly detected in neonatal ward,followed by comprehensive ward and intensive care ward.Moreover,the positive rate of the strain increased year by year,and the drug resistance rate of EsBLs-producing Klebsiella pneumoniae to common antibacterial drugs was significantly higher than that of non-enzyme producing strains,and the drug resistance rate of penicillin and second-generation cephalosporins was nearly 100%.The drug resistance rate of carbapenems was 3.0%?38.6%.According to the 2018 CHINET China Bacterial Resistance Monitoring Report,among the clinically isolated drug-resistant strains,Klebsiella pneumoniae accounted for 20.4%(28.9%),second only to Escherichia coli(28.9%),and the detection rate of carbapene-resistant Klebsiella pneumoniae(CR-KPN)continued to rise,from 4.9%in 2013 to 10.1%in 2018.In particular,the detection rates of cefotaxime or ceftriaxone resistant Klebsiella pneumoniae(CTX/CR-R-KPN)and carbapene-resistant Klebsiella pneumoniae(CR-KPN)in newborns and children were all higher than those in adults and the elderly population.Meanwhile,the annual isolation rate of Klebsiella pneumoniae also showed a steady increase.ObjectiveAnalysis summary single-center Liaocheng People's Hospital in recent 10 years children pneumonia klebsiella bacteria sepsis clinical characteristics and bacterial drug resistance as a result,to understand the status of the drug resistance,so as to the region's children pneumonia klebsiella bacteria the diagnosis of sepsis,effective and reasonable use of antibiotics,reducing the generation of drug-resistant strains provide valuable clinical information.MethodsThe clinical data of 50 children with klebsiella pneumoniae and klebsiella pneumoniae subspecies positive in blood culture from January 1,2010 to December 31,2019 in Liaocheng People's Hospital were retrospectively analyzed.According to the size of the child age 28 days(or>28 days or less)will be divided into klebsiella pneumoniae in children with sepsis newborn group of sepsis and pneumonia klebsiella bacteria than newborn group,klebsiella pneumoniae sepsis newborn group on the basis of the onset age of the children(7 days or>7 days or less),and can be divided into neonatal early-onset sepsis and neonatal late-onset sepsis groups.SPSS 25 software was used to analyze and compare the clinical department distribution,clinical characteristics,susceptibility factors,concurrent diseases,bacterial resistance analysis,treatment and clinical outcome of Klebsiella pneumoniae sepsis between the neonatal group(early-onset sepsis group,late-onset sepsis group)and the non-neonatal group.Results1.General information:Among the 50 children included in the inclusion criteria,there were 35 males and 15 females,including 35(70%),24 males(68.6%)and 11 females(31.4%)in the neonatal group(?28 days).In the non-neonatal group(>28 days),there were 15 cases(30%),12 cases(80%)in males and 3 cases(20%)in females.Among the 35 cases of neonatal sepsis,27 cases(77.1%)and 8 cases(22.9%)were in the early-onset sepsis group.The age of diagnosis was from 10 minutes to 11 years old.Among them,there were 28 cases(56%)in neonatal intensive care unit,10 cases(20%)in neonatal unit,4 cases(8%)in intensive care unit,4 cases(8%)in respiratory unit,2 cases(4%)in neurological unit,and 2 cases(4%)in hematology unit.The shortest hospitalization time was 1 day and the longest was 64 days,with an average of 22.3 days2.Clinical characteristic:The clinical manifestations of klebsiella pneumoniae sepsis in children are varied and non-specific,often involving multiple systems and organs.Newborn group most often seen as the respiratory system(85.7%),followed by the poor response,the performance of the nervous system,including early-onset sepsis is compared between group and late onset sepsis,fever was statistically difference(P<0.05),late onset sepsis group more fever,other clinical manifestations of contrast between the two groups both P values>0.05 no statistical difference,the fever(38.5? or higher)in newborns.3.History of invasive procedures and the susceptible factors:newborn group operating history,the most common for endotracheal intubation,venipuncture and CPAP,early-onset of sepsis and late onset sepsis groups contrast,venipuncture in comparison between the two groups was statistically difference(P<0.05),early-onset sepsis group more venipuncture,invasive operation comparison between the two groups both P values>0.05,no statistical difference.The common risk factors for neonatal sepsis were preterm birth,low birth weight and perinatal asphyxia,among which,there were statistically significant differences in preterm birth and low birth weight between the early sepsis group and the late sepsis group(P<0.05),while there were no statistically significant differences in perinatal asphyxia.There was no significant difference in the non-neonatal group,with bone marrow transplantation,endotrachealintubation and arteriovenous catheterization in each case.Accompanying disease:Pneumonia and congenital heart disease are the most common concomitant diseases in children with Klebsiella pneumoniae sepsis.4.Complications:pneumonia and congenital heart disease were the most common complications of klebsiella pneumoniae sepsis in the neonatal group,among which the P values of the early-onset sepsis group and the late-onset sepsis group were all>0.05,showing no statistical difference.Pneumonia is the most common non-neonatal complication.5.Drug resistance analysis:Among the 50 klebsiella pneumoniae strains,ampicillin resistance rate was the highest in the neonatal group,followed by cefazolin sodium,ceftriaxone sodium and ampicillin sodium sulbactam.The drug sensitivity of amikacin and quinolones(ciprofloxacin,levofloxacin)was 100%,and no resistant strains were produced.Carbapenem antibiotics(Meropenem,ertapenem,imipenem)had higher sensitivity and fewer resistant strains.In the newborn group is of the highest percentages of ampicillin,reaching 93.3%,followed by ampicillin sodium shu ba,ni is 82.9%,and cefazolin sodium,with nitrofurantoin,resistant rate is about 80%,and the resistance to low is a compound preparation containing enzyme inhibitors(e.g.,piperacillin/he azole temple),quinolone class(e.g.,levofloxacin,ciprofloxacin and carbon penicillium alkene antibiotics;Among carbapenems antibiotics,there were 3 strains of imipenem,Meropenem and ertapenem simultaneously resistant bacteria(6%),2 strains in the neonatal group and 1 strain in the non-neonatal group Amikacin was resistant to 2 strains,which were all in the non-neonatal group.One strain in the non-neonatal group was simultaneously resistant to ciprofloxacin and levofloxacin.6.Produce situation of ESBLs:Among the 50 included strains,36 strains of Klebsiella pneumoniae strains were tested for ESBLs,among which 27 strains(75%)were ESBLS-positive.7.Clinical outcome:Most of the children with Klebsiella pneumoniae sepsis were cured,improved and discharged from the hospital,and there were 2 deaths,all from the neonatal group.The drug sensitivity results were all positive for ESBLs,and the multi-drug resistant strains of Carbapenems enterobacter spp.(CRE)were also found.Conclusions1.The clinical characteristic of klebsiella pneumoniae sepsis in children is that it is mostly seen in the early onset sepsis in newborns,and its clinical manifestations are diverse,often involving multiple systems and organs at the same time.The most common concurrent disease is pneumonia,and the most common underlying disease is congenital heart disease.2.The risk factors for klebsiella pneumoniae sepsis in children were endotracheal intubation,intravenous catheterization,CPAP,preterm birth,low birth weight,and perinatal asphyxia.3.Klebsiella pneumoniae had the highest drug resistance rate to ampicillin,first-generation cephalosporins and cotrimoxazole.The drug resistance rate of inhibitors containing enzymes is low.The resistance rate of carbapenems,aminoglycosides and quinolones was the lowest. |
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