65例肺炎克雷伯菌中枢神经系统感染患者的临床特征及病原菌耐药性分析-现代医学

65例肺炎克雷伯菌中枢神经系统感染患者的临床特征及病原菌耐药性分析

单位：1. 南京医科大学附属脑科医院检验科江苏南京 210008;
2. 南京医科大学附属儿童医院感染管理办公室江苏南京 210008;
3. 南京医科大学附属儿童医院检验科江苏南京 210008

分类号：R446.5

出版年·卷·期（页码）：2025·53·第二期（218-222）

摘要：

目的：分析2018—2023年南京医科大学附属脑科医院、南京医科大学附属儿童医院65例肺炎克雷伯菌中枢神经系统感染患者的临床特征及病原菌的药敏试验结果，为肺炎克雷伯菌引起中枢神经系统感染的诊断及治疗提供参考依据。方法：回顾性收集2018年1月至2023年12月南京医科大学附属儿童医院及附属脑科医院患者中，临床症状符合中枢神经系统感染且脑脊液培养为肺炎克雷伯菌的患者的临床资料及药敏试验结果。结果： 65例发生肺炎克雷伯菌中枢神经系统感染的患者中，1~6个月患儿共12例，占18.5%；>60岁患者26例，占40.0%;患者主要来自重症监护室、神经外科；有16例患有胶质瘤(24.6%)、13例患有脑积水(20.0%)；耐碳青霉烯类肺炎克雷伯菌菌株对大多数抗生素的耐药率明显高于非CRKP菌株；CRKP组与非CRKP组在侵袭性操作、多联抗菌药物使用、外周血PCT>0.5 μ·L^-1、脑脊液总蛋白>0.45·L^-1的差异有统计学意义。结论：肺炎克雷伯菌中枢神经系统感染常见于低龄患儿及老人，该类患者免疫力低，并伴有严重基础疾病，耐碳青霉烯类肺炎克雷伯菌耐药情况较为严重，临床应根据患者的临床特征和病原菌的药敏结果进行合理的治疗。

Objective: The clinical features and drug susceptibility test results of 65 patients with central nervous system infection caused by Klebsiella pneumoniae in Brain Hospital Affiliated to Nanjing Medical University and Children's Hospital of Nanjing Medical University from 2018 to 2023 were analyzed to provide reference for the diagnosis and treatment of central nervous system infection caused by Klebsiella pneumoniae. Methods: Clinical data and drug susceptibility test results of patients with clinical symptoms consistent with central nervous system infection and cerebrospinal fluid culture of Klebsiella pneumoniae in Children's Hospital and Brain Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023 were retrospectively collected. Results: Among 65 cases of Klebsiella pneumoniae central nervous system infection, 12 cases(18.5%) occurred from those aged 1 to 6 months. 26 patients(40.0%) were>60 years old, mainly from the intensive care unit and neurosurgery department; There were 16 cases with glioma(24.6%) and 13 cases with hydrocephalus(20.0%);The resistance rate of carbapenem-resistant Klebsiella pneumoniae strains to most antibiotics was significantly higher than that of non-CRKP strains; There were statistically significant differences between CRKP group and non-CRKP group in invasive procedures, multi-antibiotic use, peripheral blood PCT>0.5 μ·L^-1, total protein of cerebrospinal fluid>0.45·L^-1. Conclusion: Central nervous system infection of Klebsiella pneumoniae is common in young children and the elderly. Such patients have low immunity and are accompanied by serious underlying diseases, and carbapenem-resistant Klebsiella pneumoniae is even more serious. Clinical treatment should be reasonable according to the clinical characteristics of patients and the results of drug sensitivity of pathogens.

参考文献：

[1] ZHOU Y,WANG X,SHEN J,et al.Endogenous endophthalmitis caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae:a case report and literature review[J].Ocul Immunol Inflamm,2019,27(7):1099-1104.
[2] 刘洁,杨晶,高立芳,等.天津某三甲医院耐碳青霉烯类肺炎克雷伯菌临床分布及耐药分析[J].中华医院感染学杂志,2020,30(14):2139-2143.
[3] 谭细兰,向倩如,安敏,等.影响神经外科手术后中枢神经系统感染发生的危险因素分析[J].中华神经医学杂志,2021,20(7):705-710.
[4] ANH N T,NHU L N T,HONG N T T,et al.Viral metagenomic analysis of cerebrospinal fluid from patients with acute central nervous system infections of unknown origin,vietnam[J].Emerg Infect Dis,2021,27(1):205-213.
[5] 中国医师协会神经外科医师分会神经重症专家委员会,北京医学会神经外科学分会神经外科危重症学组.神经外科中枢神经系统感染诊治中国专家共识(2021版)[J].中华神经外科杂志,2021,37(1):2-15.
[6] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:569-571.
[7] 郑孟秋,曹传顶,丁颖,等.81例新生儿化脓性脑膜炎临床分析[J].中国感染控制杂志,2020,19(5):440-446.
[8] 冯琼琼,王琍琍.新生儿化脓性脑膜炎的诊断及治疗[J].山东医药,2023,63(12):85-87.
[9] TAKAHASHI Y,HARA S,HOSHIBA R,et al.Pneumonia and central nervous system infection caused by reactivation of varicella-zoster virus in a living-donor kidney transplantation patient:case report and review of the literature[J].CEN Case Reports,2021,10(3):370-377.
[10] 刘小丽,龚林,王一梅,等.耐碳青霉烯类肺炎克雷伯菌耐消毒剂基因检测及同源性分析[J].中国感染控制杂志,2023,22(10):1218-1223.
[11] 楚新旭,邹琪,段雨辰,等.ICU临床检出革兰阴性菌的分布及耐药性分析[J].东南大学学报(医学版),2021,40(1):58-63.
[12] SANDER C,OPPERMANN H,NESTLER U,et al.Early unplanned readmission of neurosurgical patients after treatment of intrintracranial lesions:a comparison between surgical and non-surgical intervention group[J].Acta Neurochirurgica,2020,162(11):2647-2658.
[13] 中华医学会神经外科分会小儿神经外科学组.中国儿童脑积水外科治疗及并发症处理专家共识(2022版)[J].中华小儿外科杂志,2023,44(10):869-873.
[14] WS/T 779-2021儿童血细胞分析参考区间.
[15] 全国细菌耐药监测网.全国细菌耐药监测网2014-2019年脑脊液标本细菌耐药监测报告[J].中国感染控制杂志,2021,20(1):15-31.
[16] TILAHUN M,KASSA Y,GEDEFIE A,et al.Emerging carbapenem-resistant enterobacteriaceae infection,its epidemiology and novel treatment options:a review[J].Infect Drug Resist,2021,14:4363-4374.
[17] 谢兴凤,刘小青,代春梅,等.耐碳青酶烯酶肺炎克雷伯菌的流行病学特点及药物敏感性分析[J].四川医学,2023,44(3):279-284.
[18] 李阳昱,杨旭,陈孝红.耐碳青霉烯类肺炎克雷伯菌的耐药机制和治疗策略研究进展[J].现代检验医学杂志,2023,38(6):191-199.
[19] LEE Y L,CHEN H M,HII I M,et al.Carbapenemase-producing enterobacterales infections:recent advances in diagnosis and treatment[J].Int J Antimicrob Ag,2022,59(2):106528.
[20] 阿力米热·艾买提,丁丽,伊思达,等.耐碳青霉烯类肺炎克雷伯菌感染治疗进展[J].中国感染与化疗杂志,2022,22(6):779-784.
[21] 罗可人,唐军.肺炎克雷伯菌抗生素耐药性的研究进展[J].中国抗生素杂志,2020,45(6):540-544.
[22] 唐洪影,李静,宋缘缘,等.耐碳青霉烯类肺炎克雷伯菌感染及预后相关因素分析[J].天津医科大学学报,2019,25(3):271-284.
[23] 孙胜君,张昌莲,赵自云.医院碳青霉烯耐药肺炎克雷伯菌的耐药特征分析[J].中国实验诊断学,2022,26(4):515-518.
[24] 刘松,陈晖,李宗海,等.肺炎克雷伯杆菌侵袭性感染的临床特点[J].山东医药,2023,63(9):90-93.
[25] 王蕾,孔芝,王凤娟,等.降钙素原联合乳酸检测在术后细菌性颅内感染诊断中的应用[J].中国临床神经外科杂志,2021,26(9):708-710.
[26] 余青虹,程杰,徐慧婷,等.儿童肺炎克雷伯菌血流感染临床特征及菌株药物敏感性分析[J].中国抗生素杂志,2022,47(6):610-615.
[27] 师志云,马苗,尹晓丽,等.碳青霉烯类耐药肺炎克雷伯菌的耐药性及毒力特征的分子生物学研究[J].中国感染与化疗杂志,2022,22(6):725-731.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录