| 摘要: |
| 目的 探讨美罗培南治疗新生儿耐碳青霉烯类肺炎克雷伯菌（CRKP）败血症的疗效及其影响因素，为临床合理使用抗生素提供参考依据。方法 采用回顾性研究方法，收集2014年6月至2018年6月在上海交通大学附属儿童医院新生儿科住院的27例CRKP败血症患儿的临床资料，分析美罗培南在27例患儿中的治疗效果。根据治疗效果将患儿分为美罗培南单药治疗有效组和美罗培南单药治疗无效需联合治疗组，比较两组患儿围产因素、感染CRKP前接受碳青酶烯类抗生素暴露等临床特点的差异。结果 美罗培南单药治疗新生儿CRKP败血症有效率为48.1%（13/27），采用联合治疗后总体有效率为74.1%（20/27）。美罗培南单药治疗无效需联合治疗组患儿存在外科手术后开放性伤口（7/14 vs 1/13）、感染性休克（7/14 vs 1/13）、无菌体腔液（脑脊液及腹水）培养阳性（6/14 vs 0/13）、感染时需有创机械通气（10/14 vs 1/13）的患儿比例高于单药治疗有效组（P均<0.05），纸片扩散法药物敏感性试验中美罗培南抑菌圈直径小于单药治疗有效组[（9.14±3.37）mm vs（12.85±5.27）mm，P<0.05]。结论 美罗培南单药治疗新生儿CRKP败血症具有一定疗效。当CRKP败血症患儿存在外科手术后开放性伤口、感染性休克、无菌体腔液培养阳性、感染时需有创机械通气及药物敏感性试验中美罗培南抑菌圈直径偏小时需联合治疗，以提高治疗有效率。 |
| 关键词: 新生儿 美罗培南 耐碳青霉烯类肺炎克雷伯杆菌 败血症 |
| DOI：10.16781/j.0258-879x.2019.07.0812 |
| 投稿时间：2019-02-27修订日期：2019-05-14 |
| 基金项目:上海市科学技术委员会科研计划项目（134119a0500）. |
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| Meropenem in treatment of neonatal carbapenem-resistant Klebsiella pneumoniae sepsis: an analysis of 27 cases |
| WANG Jun-fang,GONG Xiao-hui*,QIU Gang,CAI Cheng,YAN Chong-bing,HONG Wen-chao |
(Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
*Corresponding author) |
| Abstract: |
| Objective To explore the efficacy of meropenem in the treatment of neonatal carbapenem-resistant Klebsiella pneumoniae (CRKP) sepsis and its influencing factors, so as to provide reference for reasonable use of antibiotics in clinic. Methods A total of 27 neonates who were diagnosed as CRKP sepsis in Shanghai Children's Hospital from Jun. 2014 to Jun. 2018 were included in this retrospective study. The clinical efficacy of meropenem was evaluated and the patients were divided into two groups:meropenem monotherapy effective group and meropenem monotherapy ineffective group who required other antibiotics for combination therapy. The perinatal factors, prior exposure to carbapenems and other clinical characteristics were compared between the two groups. Results The effective rate of meropenem monotherapy in treating neonatal CRKP sepsis was 48.1% (13/27), and the overall effective rate was 74.1% (20/27) when another antibiotic was added. The incidences of open wound after surgery (7/14 vs 1/13), septic shock (7/14 vs 1/13), positive culture of sterile coelomic fluid (6/14 vs 0/13), and invasive mechanical ventilation (10/14 vs 1/13) were higher in meropenem monotherapy ineffective group than in meropenem monotherapy effective group (all P<0.05), and the diameter of CRKP inhibition zone in meropenem monotherapy ineffective group was smaller than that in meropenem monotherapy effective group ([9.14±3.37] mm vs[12.85±5.27] mm, P<0.05). Conclusion Meropenem monotherapy is effective for treatment of neonatal CRKP sepsis. Other antibiotics are recommended when the patients also have open wound after surgery, septic shock, positive culture of sterile coelomic fluid, invasive mechanical ventilation, or smaller inhibition zone of CRKP on meropenem. |
| Key words: neonate meropenem carbapenem-resistant Klebsiella pneumoniae sepsis |
