目的 了解新生儿患者多重耐药菌社区感染的特点和定植情况，采取预防控制措施，防止在院内传播。 方法 对2011年9月－2012年8月所有新入院新生儿患者共801例进行耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）和产超广谱β内酰胺酶（ESBL）菌入院筛查，了解多重耐药菌社区感染的特点和定植情况。并将801例新生儿患者（观察组）医院感染发生率与2010年9月－2011年8月同期801 例新生儿患者（对照组）医院感染发生率进行比较。 结果 观察组发现MRSA和产ESBL菌共321例，检出率为40.1%。其中包括单纯MRSA 45例，占14.1%；产ESBL菌238例，占74.1%；MRSA+产ESBL菌38例，占11.8%。观察组医院感染发生率为2.0%，多重耐药菌医院感染构成比为12.5%；对照组医院感染发生率为5.1%，多重耐药菌医院感染构成比为53.6%；两组医院感染发生率和多重耐药菌医院感染构成比差异均有统计学意义（P＜0.01）。 结论 新生儿患者多重耐药菌定植情况严重，应引起高度重视，加强管理可防止在医院传播，减少医院感染发生。
ObjectiveTo compare the clinical characteristics of patients with nosocomial and community infections with extended-spectrum beta-lactamase-containing Klebsiella pneumoniae (ESBL-KP) and non-ESBL-KP so as to improve clinical diagnosis and treatment outcomes.MethodsThis retrospective study determined the clinical features of patients with nosocomial and community infections with KP who were admitted to our hospital from January 1st, 2017 to June 30th, 2018. The chi-square test or Fisher's exact probability method were used to compare different groups.ResultsWe identified 334 strains of KP, and 83 (24.9%) of them strains were EBSL-KP. The percentages of ESBL-KP infections among those with nosocomial and community infections were similar (31.25% vs. 22.27%, χ2=2.955, P=0.086). Significantly more females than males had ESBL-KP infections (32.32 vs. 21.70%, χ2=4.208, P=0.040). The percentages of ESBL-KP infections were similar among <18 years-old group, 18 to 45 years-old group, 45 to 60 years-old group, and ≥60 years-old group. The three major locations of KP infections were the lower respiratory tract, urinary tract, and bloodstream (bacteremia). Among nosocomial KP infections, there were no significant differences in the percentages of ESBL-KP infections at different sites, nor in the hospital departments where patients were treated; among community KP infections, there were significant differences in the percentages of ESBLs-KP infections at different sites, and in the hospital departments where patients were treated. For community KP infections, the two most common infection sites were the urinary tract (37.74%) and the skin and soft tissue (30.77%), and most patients were treated in the urology department (40.00%) and respiratory medicine department (38.10%). ESBL-KP isolates had greater resistance than non-EBSL-KP isolates to 16 tested antibiotics (P<0.05). There were no statistically significant differences in the percentages of nosocomial infections and community infections among those with ESBL-KP and among those with non-ESBL-KP (P>0.05).ConclusionsOur population have high rates of nosocomial and community KP infections and of infections with ESBL-KP. It is necessary to strengthen the management and clinical use of antibiotics and to provide real-time surveillance of KP infections, especially for patients with ESBL-KP infections. Increased vigilance is required for KP infections of females and community KP infections to improve control of nosocomial infections and reduce the prevalence of cross-infections.