肺结核并发肺炎克雷伯菌感染的检测及其耐药性分析  

The detection and drug-resistance analysis for pulmonary tuberculosis complicated with Klebsiella pneumoniae

作　　者：冯胜春[1] 

机构地区：[1]金华市中心医院检验科,浙江金华321000

出　　处：《中国卫生检验杂志》2015年第3期435-437,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的了解从肺结核患者下呼吸道标本中分离肺炎克雷伯菌对抗菌药物耐药性变迁情况,为临床预防和治疗肺炎克雷伯菌感染提供依据。方法对2004年-2013年本院细菌耐药监测资料中肺炎克雷伯菌临床分离株的耐药性进行分析,药敏试验采用K-B法,按CLSI 2012年标准判定药敏结果,用WHONET 5.6软件分析数据。结果临床分离肺炎克雷伯菌对抗菌药物药敏试验结果显示,产ESBLs菌和非产ESBLs菌对β-内酰胺酶类和非β-内酰胺酶类抗菌药物的耐药率均显著增高（P〈0.05）,对亚胺培南和美罗培南都保持高度敏感,耐药率均低于5%;2004年-2013年该菌产ESBLs者增多（20.6%-55.7%）。结论从肺结核患者下呼吸道标本中分离出的肺炎克雷伯菌对常用抗菌药物的耐药性10年间呈普遍增长趋势,ESBLs检出率总体呈上升趋势,对碳青霉烯类抗菌药物仍保持高度敏感性,临床应重视肺结核患者肺炎克雷伯菌感染并依据药敏试验结果合理选用抗生素。Objective To investigate the changes of antibacterial drug resistance of Klebsiella pneumonia isolated from lower respiratory tract specimens in pulmonary tuberculosis patients,so as to provide basis for the prevention and treatment of Klebsiella pneumonia infection. Methods The monitoring data of bacterial resistance of clinical Klebsiella pneumonia isolates in the hospital was analyzed. Conducted susceptibility testing using the K- B method,according to CLSI 2012 standard to determine drug susceptibility results,and analyzed the results using WHONET 5. 6 software. Results The susceptibility test results of clinical isolates of Klebsiella pneumonia to antimicrobial drug showed thatthe resistance rates of ESBLs- producing bacteria and non ESBLs- producing bacteria on β- lactamase and non- β- lactamase antimicrobial drug were significantly higher（ P〈0. 05）,which still remained high sensitivity to imipenem and meropenem,resistance rate was less than 5%; During 2004- 2013 ESBLs producing bacteria increased（ 20. 6% - 55. 7%）. Conclusion The antibacterial drug resistance of Klebsiella pneumonia isolated from lower respiratory tract specimens in pulmonary tuberculosis patients showed growing tendency in the last 10 years. ESBLs detection rate showed overall upward trend. It still remains high sensitivity to carbapenem antibacterial drugs. Should attach importance to clinical pulmonary tuberculosis Klebsiella pneumonia infections and use antibiotics based on drug- sensitive test results reasonably.

关 键 词：肺结核 肺炎克雷伯菌 下呼吸道感染 耐药性 

分 类 号：R446.5[医药卫生—诊断学]