2006-2010年秦皇岛地区临床分离肺炎克雷伯菌耐药性分析  

Antimicrobial Resistance Among Clinical Isolates of Klebsiella Pneumonia in Qinhuangdao,2006-2010

作　　者：张岩[1] 杜学娜 么建立[2] 董爱英[3] 张丽娜[4] 张晓玲[1] 

机构地区：[1]河北港口集团有限公司港口医院检验科,河北秦皇岛066022 [2]秦皇岛市第三医院检验科 [3]河北联合大学附属医院检验科 [4]秦皇岛市第一医院检验科

出　　处：《预防医学情报杂志》2013年第5期418-421,共4页Journal of Preventive Medicine Information

摘　　要：目的分析2006-2010年秦皇岛地区肺炎克雷伯菌耐药性的变化,探究产生超广谱β-内酰胺酶(ESBLs)和碳青霉烯酶的趋势。方法肺炎克雷伯菌菌株的鉴定、药敏试验采用黑马半自动细菌分析系统,用微量肉汤法确认肺炎克雷伯菌产生ESBLs情况,用改良Hodge试验确认肺炎克雷伯菌产碳青霉烯酶的情况;感染分布统计采用WHONET 5.3软件。结果 2006-2010年秦皇岛地区临床各类标本中分离出肺炎克雷伯菌605株,前4位分别是:呼吸道标本分离371株,中段尿分离85株,脓、伤口及其他分泌物中分离78株,血中分离32株;肺炎克雷伯菌对亚胺培南、美罗培南耐药率很低(2006年0.0%,2010年6.1%),对头孢吡肟的耐药率低于23.6%,抗菌药物耐药率大于90%(2006年90.6%,2010年93.2%)为氨苄西林,对其他抗菌药物耐药率均小于70%;但整体上肺炎克雷伯菌对各种抗生素的耐药率呈逐年上升的趋势。5年平均ESBLs分离率为37.5%;共检出2株肺炎克雷伯菌为改良Hodge试验阳性。结论 2006-2010年秦皇岛地区肺炎克雷伯菌对各种抗生素的耐药率呈逐年上升的趋势,碳青霉烯类对肺炎克雷伯菌高度敏感,是最有效的一类抗菌药物。Objective To analyze the drug - resistance trends of Klebsiella pneumonia and its infection distribu-tion, and to explore the status of producing extended spectrum β - lactamases （ ESBLs ） and Klebsiella pneumonia carbapenemase in Qinhuangdao. Methods I- dentification and drug susceptibility testing of Klebsiella pneumoniae stains were detected by HEMA semi - auto-matic analysis system of bacteria. Broth dilution method was applied to confirm situation of Klebsiella pneumoniae produced ESBLs. The modified Hodge test was used to confirm situation of Klebsiella pneumoniae produced KPC enzymes. WHONET5.3 software was used to analyze the date of clinical distrubition. Results There were 605 stains of Klebsiella pneumoniae isolated from all kinds of clinical specimens in Qinhuangdao during 2006 -2010. The top four were respiratory tract specimens （371 stains）, midstream urine （85 stains）, secre- tions （78 stains） and blood specimens （32 stains）. The resistance rates to Imipenem and Meropenem were very low （0. 0% -6. 1% ）, the resistance rate to Cefepime was lower than 23.6%, while the resistance rate to Am- picillin were higher than 90%. To other antibacterials the resistance rates were lower than 70%. ESBLs detec- tion rate in Klebsiella pneumoniae increased year by year. Compared 2010 with 2006, the isolation rate of ES- BLs showed significant difference. ESBLs detection rate in Klebsiella pneumoniae was 37.5% in these five years. Two stains were modified Hodge test positive. Conclusions The resistance rate of Klebsiella pneumoniae to various antibiotics showed an upward trend year by year in Qinhuangdao 2006 -2010. Strains of Klebsiella pneumoniae were still highly susceptible to Carbapenem. More attention should be paid to the detection of ES- BLs and Klebsiella pneumoniae carbapenemase.

关 键 词：肺炎克雷伯菌 超广谱Β-内酰胺酶 耐药性 改良HODGE试验 

分 类 号：R915[医药卫生—微生物与生化药学]