肺炎克雷伯菌医院感染监测及耐药性分析  

Nosocomial Infections and Drug Resistance of Klebsiella pneumoniae

作　　者：李振江[1] 孙长贵[1] 曾贤铭[1] 杨燕[1] 张丽君[1] 成军[1] 

机构地区：[1]解放军第117医院,浙江杭州310013

出　　处：《中华医院感染学杂志》2007年第6期737-739,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解医院肺炎克雷伯菌感染分布和耐药情况,指导临床合理选择抗菌药物。方法采用VITEK-32微生物鉴定仪鉴定,ESBLs菌株鉴定用复合纸片表型确证法、纸片扩散法药敏试验并应用WHONET5.3软件进行统计分析。结果256株肺炎克雷伯菌中痰液、尿液、血液和分泌物标本占93.6%,其中痰液54.3%;感染菌株主要分布于ICU、干部病房和内科,占81.6%;产ESBLs菌株占39.8%;所有受试菌株对临床常用的多种抗菌药物耐药率在32.4%~50.0%;但头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟、头孢西丁和阿米卡星等耐药率〈22.7%,产ESBLs菌株对所测试的抗菌药物（除亚胺培南和美罗培南外）耐药率明显高于非产ESBLs株（P〈0.05）,49.0%产ESBLs菌株呈多重耐药性。结论医院内肺炎克雷伯菌临床分离株对抗菌药物耐药率及产ESBLs菌株阳性率较高,产ESBLs菌株多重耐药现象突出,临床应重视其流行情况并合理使用抗菌药物。OBJECTIVE To investigate the distribution and the drug resistance of Klebsiella pneumoniae in our hospital, and provide reference for the rational use of antimicrobial agents in clinic. METHODS The strains of K. pneumoniae isolated from clinical samples were identified by the VITEK-32 system. Extended spectrum β- lactamases（ESBLs） were determined by phenotypic confirmatory test. Susceptibility test to antimicrobial agents was performed by disk diffusion methods and analyzed by WHONET 5.3. RESULTS 93.6 % Of total 256 strains of K. pneumoniae were isolated from urine, sputum, blood and secretion samples, and 54.3% of them were isolated from sputum. 81.6 % Of infections caused by K. pneumonlae were frequently occurred in patients in intensive care units （ICU）, departments of respiratory medicine and gastroenterology, departments of hematology and endocrinology, cadred wards and department of nephrology. The isolated ratio of ESBLs producing K. pneumoniae were 39. 8%. The rates of resistance to piperacillin, cefuroxime, ceftazidime, cefotaxime, ceftriaxone, aztreonam, gentamicin, ciprofloxacin, and sulfamethoxazole/trimethoprim were between 32.4% and 50% in all strains; and the resistance rate to cefoperazone/sulbactam, piperacillin/tazobactam, cefepime, cefoxitin, and amikacin was less than 22.7 %. There were isolates producing ESBLs, which showed much higher resistance to antimicrobial agents tested（but susceptible to imipenem and meropenem） than that of non-ESBLs- producing K. pneumoniae（P〈0.05）. 49 % Of ESBLs producing strains were multidrug resistant. CONCLUSIONS Antimicrobial resistance and the isolation rates of ESBLs producing K. pneumoniae in our hospital are high, and the situation of multidrug resistance of ESBLs producing strains is very prominent. It should be paid attention to the epidemic status of strains and rational use of antimicrobials agents in clinic.

关 键 词：肺炎克雷伯菌 抗菌药物 耐药性 医院感染 

分 类 号：R378[医药卫生—病原生物学]