克雷伯氏菌致婴幼儿腹泻流行病学分析

目的 :探讨克雷伯氏菌致婴幼儿腹泻的临床流行病学特点及治疗方法。方法 :按常规方法取新鲜粪便 ,将其接种在SS与EMB琼脂平板上放置 3 6℃过夜 ,挑取可疑菌落进行生化反应与血清学鉴定 ,确定细菌种类后作药敏试验。结果 :我院自 2 0 0 1年 5月～ 2 0 0 2年 5月住院和部分门诊腹泻病例共检出机会菌感染粪便 45 8例 ,在肠道菌选择性培养基上纯培养出克雷伯氏菌株 13 6株 ,占 3 9 69%。其中肺炎克雷伯臭鼻亚菌 12 5株 ( 91 91% ) ,产酸克雷伯氏菌 11株 ( 8 0 9% )。克雷伯氏菌致婴幼儿腹泻临床流行病学特点 :1岁以内小儿发病率高。一年四季均可发病 ,以夏、秋季为发病高峰 ,分别为 3 2 3 %、2 0 5 8%。临床表现不典型 ,可表现急性腹泻 ,也可迁延不愈、慢性腹泻。大便多呈黄稀水样便、黄绿粘便 ,未见脓血便。每日 5～ 6次 ,严重者达 10次以上。出现脱水及电解质紊乱 ,多见低钠血症。大便常规检查多正常或镜检脂肪球 +～++,白细胞 +,临床上很难作出病原学诊断。结论 :对小儿腹泻病人应常规作粪便培养 ,合理使用抗生素及微生态药物 ,以维持正常肠道菌群。

Epidemiological analysis of infants and young children diarrhea caused by Klebsialla

Objective: To study the clinical epidemiological characteristics and treatment methods of infants and young children diarrhea caused by Klebsialla.Methods: Fresh fecal samples were collected in routine ways and cultured on SS and EMB agar platelets for one night at 36 ℃.Suspect bacterial colonies were selected for further detection with biochemical response and serological identification.Then Drug sensitivity tests were conducted once the pathogen was identified.Results: Among 458 opportunistic bacterial infected stool species from the hospitalized patients and part outpatients attending our hospital during 2001.5～2002.5, Klebsialla was detected by enteropathogen selective medium culture in 136 samples, taking for 39.69%.Among which 125 strains were K.ozaenae subtype of K.pneumoniae(91.91%) and 11 strains were producing acid Klebsialla ( 8.09%).The clinical epidemiological characteristics of the infants and young children diarrhea caused by Klebsialla:the morbidity rate was high in cases aged under 1 year;This disease could occur in every season but more frequently in summer and autumn(the rate was 32.3% and 20.58% respectively);clinical manifestations were not distinct ,such as acute diarrhea,prolonged diarrhea or chronic diarrhea;stools could be yellow watery,greenyellow sticky but not mucobloody; diarrhea was often 5～6 times a day,sometimes over 10 times when serious;dehydration and electrolytic disorder (hyponatremia was more often) could be often observed;routine stool detection always showed normal or fat globules (+～++),leukocytes(+).So it was difficult to make a pathogenic diagnosis by clinical diagnosis alone. Conclusion: For young children diarrhea,stool culture should be conducted and suitable antibiotics and microecological drug can be administered to protect the intestinal normal flora.