肺炎克雷伯菌所致外科血流感染的临床特点及细菌耐药性  

Clinical characteristics and antimicrobial resistance profile of nosocomial bloodstream infections caused by Klebsiella pneumoniae in surgical patients

作　　者：张小兵[1] 唐世龙[1] 卢强[1] 张万宇[1] 

机构地区：[1]中山大学附属东华医院普外二科,广东东莞523110

出　　处：《中国感染与化疗杂志》2017年第4期361-364,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的回顾性分析外科患者中肺炎克雷伯菌所致血流感染的临床特点及病原菌耐药性,为外科临床合理选用抗菌药物控制感染提供依据。方法参照卫生部医院感染诊断标准,回顾性分析中山大学附属东华医院2013年1月-2015年6月所有血培养所获肺炎克雷伯菌的外科患者病史。按常规方法进行细菌分离、鉴定,细菌药物敏感试验采用纸片扩散法,采用WHONET 5.6软件进行分析。结果由肺炎克雷伯菌所致的医院获得性血流感染的外科患者共78例,原发性血流感染占12.8%(10/78),继发性血流感染占87.2%(68/78),主要与手术及侵袭性操作等因素相关。药敏结果显示肺炎克雷伯菌对头孢曲松、头孢呋辛和哌拉西林的耐药率接近40%。产ESBL肺炎克雷伯菌(占43.6%)对各抗菌药物的耐药率明显高于非产ESBL株。哌拉西林-他唑巴坦、阿米卡星、亚胺培南和美罗培南对该菌仍有较好的抗菌活性,但出现了耐亚胺培南株。结论外科患者中肺炎克雷伯菌血流感染以继发性感染多见,应加强医院感染控制;同时,积极送检微生物标本进行培养和药敏测定,依据药敏结果,合理选用抗生素。Objective To retrospectively review the clinical characteristics and antimicrobial resistance profile of nosocomial bloodstream infections caused by Klebsiella pneumoniae in surgical patients for better use of antimicrobial agents. Methods The clinical data of the surgical patients who were diagnosed with K. pneumoniae-associated bloodstream infections in Tung Wah Hospital from January 2013 to June 2015 were reviewed and analyzed retrospectively. The diagnosis of bloodstream infections was based on national diagnostic criteria. The pathogens were routinely isolated and identified. Antimicrobial susceptibility testing was carried out by using Kirby-Bauer method. The data were analyzed by WHONET 5.6 software. Results A total of 78 surgical patients were identified with nosocomial bloodstream infections due to K. pneumoniae during this period, including primary bloodstream infections （12.8%, 10/78） and secondary bloodstream infections （87.2%, 68/78）. These infections were mainly associated with surgical and invasive procedures. Nearly 40% of the K. pneumoniae isolates were resistant to ceftriaxone, cefuroxime and piperacillin. ESBLs were produced in 43.6% （34/78） of the K. pneumoniae isolates. The ESBLs-producing strains showed significantly higher resistance rates to various antibiotics than non-ESBLs-producing strains. Piperacillin-tazobactam, amikacin, imipenem, and meropenem still have good antibacterial activity against these K. pneumoniae isolates. However, imipenem-resistant strains are emerging. Conclusions Most of the bloodstream infections caused by K. pneumoniae were secondary to infections in other body sites in surgical patients. Hospital infection control measures should be strengthened. Meanwhile, the clinicians should take full advantages of microbiological laboratory to profile the pathogens and their susceptibility patterns, which is crucial for rational use of antibiotics.

关 键 词：血流感染 肺炎克雷伯菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R515[医药卫生—临床医学]