【摘要】 目的了解我院2008年1月—2011年12月临床分离肺炎克雷伯菌分布特征及耐药现状,为临床预防和控制感染提供依据。方法常规分离菌株,采用纸片扩散法进行抗菌药物的敏感试验,双纸片协同试验进行超广谱β-内酰胺酶(ESBLs)检测,用WHONET5.5和SPSS17.0软件进行数据统计分析。结果 2008年1月—2011年12月共检出肺炎克雷伯菌855株,在重症监护病房(ICU)检出率最高(29.3%),其次为呼吸内科(17.2%)、神经外科(15.5%)。临床标本主要来源于痰液(68.9%)、尿液(8.1%)、分泌物(6.2%)。肺炎克雷伯菌对氨苄西林的耐药率高达96.9%,对哌拉西林的耐药率为48.0%,除头孢西丁外,对第一代至第四代头孢菌素的耐药率在34.3%~51.1%,对头孢西丁的耐药率为17.2%,对哌拉西林/三唑巴坦、头孢哌酮/舒巴坦、阿米卡星的耐药率均低于12%,对亚胺培南耐药率为6.3%,对美罗培南和厄他培南的耐药率分别为3.6%、4.2%。2011年肺炎克雷伯菌对碳青霉烯类抗生素的耐药率较前3年明显降低,以亚胺培南最为显著。肺炎克雷伯菌产ESBLs率平均为35.2%,产ESBLs菌株对大多数抗菌药物的耐药率显著高于非产ESBLs菌株(P<0.05)。ICU内肺炎克雷伯菌对大多数抗菌药物的耐药率高于非ICU(P<0.05)。结论肺炎克雷伯菌临床分离株数较多,对各类抗菌药物呈现不同程度的耐药,耐药性严重,有些具有多重耐药的特点,医院应对其加强耐药性监测和控制工作,尤其是ICU内的菌株;治疗肺炎克雷伯菌感染可选择碳青霉烯类、哌拉西林/三唑巴坦、头孢哌酮/舒巴坦、阿米卡星,但已出现这些抗菌药物的耐药株,应引起重视。更多还原

【Abstract】 Objective To investigate the distribution and antibiotic resistance of Klebsiella pneumoniae isolated from our hospital during the period of Jan 2008-Dec 2011.Methods All strains of K.pneumoniae were isolated from routine clinical specimens and characterized by Kirby Bauer antibiotic sensitivity testing and a double disk synergy testing for detection of extend-spectrum β-lactamase(ESBLs).Date were analyzed by WHONET5.5 and SPSS17.0 softwares.Results The majority of 855 strains isolated were from ICU(29.3%;with higher resistance rates than non-ICU isolates),followed by respiratory department(17.2%) and neurosurgery department(15.5%).The K.pneumonia-positive specimens were mostly derived from sputum(68.9%),urine(8.1%),and secretion(6.2%).The rates of resistance to different antibiotic agents were as follows: 96.9% for ampicillin,48.0% for piperacillin,and 34.3%~51.1% for the first to fourth-generation cephalosporins except for cefoxitin(17.2%),less than 12.0% for piperacillin/tazobactam,cefoperazone/sulbactam or amikacin,6.3% for imipenem,3.6% for meropenem,and 4.2% for ertapenem.Compared with those in 2008-2010,the rates of resistance to carbapenems in 2011 has significantly decreased,especially to imipenem.ESBLs-producing K.Pneumoniae was detected in 35.2% of the isolates.The rates of resistance to most antibiotics in ESBL-positive K.pneumoniae were higher than ESBL-negative counterparts.Conclusion Clinical isolates of K.pneumoniae have displayed high degrees of resistance(including multidrug resistance) to various antibiotic agents.Thus,the hospitals should strengthen the monitoring programs and take intervention measures in controlling resistance development and spread,especially in ICU.Although carbapenems,pipercillin/tazobactam,cefoperazone/sulbactam and amikacin can be chosen for treatment of K.pneumoniae infections,the development of resistance to these agents should be considered.更多还原