肺炎克雷伯菌感染的临床分布及耐药性分析  

Analysis of distribution and drug resistance of Klebsiella pneumoniae

作　　者：张晓妹[1] 田露[2] 范敏[3] 卢景辉[4] 陈思聪[4] 李昕[4] 张扣兴[3] 

机构地区：[1]广东药学院附属第一医院老年科,广东广州510080 [2]广东药学院附属第一医院影像科,广东广州510080 [3]中山大学附属第三医院普内科,广东广州510630 [4]广东药学院附属第一医院检验科,广东广州510080

出　　处：《热带医学杂志》2015年第7期956-958,共3页Journal of Tropical Medicine

摘　　要：目的分析医院临床分离的肺炎克雷伯菌的分布及耐药性,为临床合理用药提供实验室依据。方法收集2010年1月至2013年12月广东药学院附属第一医院临床分离的肺炎克雷伯菌1 032株,经常规生化方法及美国BD公司的PHoenix TM 100全自动细菌鉴定/药物敏感分析仪进行鉴定并检测对20种常用抗菌药的药物敏感性,使用WHONET 5.4软件和SPSS17.0软件进行数据统计分析。结果1 032株肺炎克雷伯菌在痰液标本中检出最多,占56.0%;科室分布以重症监护病房及呼吸内科为主,分别占18.4%及15.2%;产β-内酰胺酶肺炎克雷伯菌共617株,总检出率为59.8%,无逐年递增的态势（P〉0.05）;肺炎克雷伯菌对碳青霉烯类抗菌药的耐药率由0上升至6.3%;对氨苄西林的耐药率为100%,哌拉西林、头孢唑啉、头孢噻肟、头孢曲松、头孢克洛、头孢呋辛耐药率均在58%~73%之间,阿米卡星、头孢哌酮/舒巴坦有较好的敏感性,耐药率分别为9.3%~31.2%及7.8%~22.8%。结论肺炎克雷伯菌耐药情况较严重,尤其是对碳青霉烯类抗菌药耐药性明显增加,应加强耐药性监测,防止医院内流行。Objective To provide references for therapy of infections by analyzing the distribution and drug resistance of Klebsiella pneumoniae. Methods A total of 1 032 strains of Klebsiella pneumoniae were isolated from January 2010 to December 2013 in the First Affiliated Hospital of Guangdong College of Pharmacy. All these strains were identified by the conventional biochemical methods and PHoenixTM100 automatic bacteria identification system. Susceptibility of 20 common antibiotics were tested by minimal inhibitory concentration （MIC） method, which had been carried out by PHoenixTM100 automatic bacteria sensitivity test system. The data were analyzed by WHONET 5.4 and SPSS 17.0. Results 56.0% of the 1 032 strains of KlebsieUa pneumoniae were distributed mainly in the sputum. The bacteria were mainly distributed in intensive care units（18.4%） and respiratory medicine （15.2%）. The positive rate of ESBLs was 59.8% without an increased trend （P〉0.05）. Resistance of Klebsiella pneumoniae to imipenem and meropenem were both increased from 0 to 6.3%. The resistance rate to ampicillin was 100%, and 58%-73% to piperacillin, cefazollin, cefotaxime, ceftriaxone, cefaclor and cefuroxime. The resistance rate to Amikacin and cefoperazone/sulactam was lower, accounting for 9.3%-31.2% and 7.8%-22.8%, respectively. Conclusion The antibiotic resistance of Klebsiellapneumoniae is quite serious, and the strains of carbapenemresistant Klebsiella pneumoniae were increased markedly. It is necessary to strengthen the surveillance to prevent the spread of the drug resistant strain in hospital.

关 键 词：肺炎克雷伯菌 超广谱Β-内酰胺酶 耐药性 

分 类 号：R378.99[医药卫生—病原生物学]