神经外科ICU与普通ICU病区患者分离肺炎克雷伯菌耐药性比较  

Klebsiella pneumoniae isolated from Neurosurgical ICU and General ICU wards: a comparison of drug resistance

作　　者：刘小军 

机构地区：[1]温州市永嘉县人民医院外科,浙江永嘉325100

出　　处：《中国微生态学杂志》2014年第5期558-560,563,共4页Chinese Journal of Microecology

摘　　要：目的分析温州市永嘉县人民医院神经外科ICU和普通ICU病区患者分离肺炎克雷伯菌的标本来源及耐药性的差异,为指导患者合理使用抗生素提供依据。方法采用回顾性分析方法对该院神经外科ICU和普通ICU病区五年来分离的肺炎克雷伯菌的标本来源及药敏结果进行分析,并运用统计学软件Whonet 5.4进行耐药分析。结果五年来该院神经外科ICU分离的肺炎克雷伯菌123株来自痰液,占51.68%;52株来自尿液,占15.97%;38株来自血液,占21.85%;12株来自脓液,占5.04%;8株来自引流液,占3.36%。而普通ICU病区分离肺炎克雷伯菌164株来自痰液,占41.72%;68株来自血液,占22.52%;53株来自尿液,占17.55%;35株来自引流液,占11.59%;12株来自脓液,占3.97%。对药敏结果分析发现,神经外科ICU分离株对头孢噻肟、头孢他啶、头孢吡肟、头孢曲松、阿米卡星、亚胺培南及美罗培南的耐药率大部分高于普通ICU分离株,而对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、环丙沙星及左氧氟沙星的耐药率低于普通ICU分离株。结论该院神经外科ICU分离肺炎克雷伯菌的标本来源及耐药性与普通ICU分离肺炎克雷伯菌存在显著差异,针对不同ICU病区分离菌株的抗生素选择也有所不同。Objective To analyze the difference of the distribution and drug resistance of Klebsiella pneumoniae be- tween the neurosurgery ICU and the general ICU wards, in order to direct reasonable use of antibacterial agents. Methods A retrospective analysis was used to study the difference of the distribution and susceptibility results of Klebsiella pneumoniae （KP） between neurosurgical ICU and general ICU wards in five years. Whonet 5.4 was used for drug resistance analysis. Results Among the KP isolated from neurosurgical ICU, 123 strains were from sputum （51. 68% ）, 52 strains from urine （15.97%） 38 strains from blood （21. 85%）, 12 strains from pus （5.04%）, and 8 strains from drainage fluid （3.36%）. However, in general ICU ward, there were 164 stains from sputum （41.72%）, 68 strains from blood （22.52%）, 53 strains from urine （17.55%）, 35 strains from drainage fluid （ 11.59% ） and 12 strains from pus （ 3.97% ）. The resistance rates of the isolates from neurosurgery ICU to cefotaxime, ceftazidime, cefepime, ceftriaxone, amikacin, imipenem and meropenem were higher than the isolates from ICU, while their resistance rates to piperacillin/tazobactam, cefoperazone/sulbactam, ciprofloxacin and levofloxacin were lower. Conclusion In our hospital, there are significant differences amongst the specimen distribution and antibiotic resistance of Klebsiella pneumoniae between the neurosurgical ICU and general ICU. The choice of antibiotics should be based on the isolates from different ICU wards.

关 键 词：肺炎克雷伯菌 神经外科ICU 普通ICU 

分 类 号：R378.996[医药卫生—病原生物学]