大肠埃希菌和肺炎克雷伯菌的临床分布及耐药监测  

Clinical distribution and drug resistance monitoring of Escherichia coli and Klebsiella pneumoniae

作　　者：汪璐[1] 曲远青 

机构地区：[1]成都军区总医院检验科,四川成都610038

出　　处：《中国实验诊断学》2017年第11期1893-1896,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的研究大肠埃希菌和肺炎克雷伯菌的临床分布及耐药情况,为临床合理用药提供临床参考。方法采用法国生物梅利埃VITEK2COMPACT全自动微生物鉴定分析仪对2016年1月到2016年12月我院临床各类标本分离的大肠埃希菌及肺炎克雷伯进行鉴定及药敏分析。结果 1920株大肠埃希菌检出最多的标本分别为中段尿(38.28%),痰液(29.11%),脓液(11.15%),1920株大肠埃希菌ESBLs阳性株943株,阳性率49.11%,其中以积液ESBLs阳性率(64.44%)、创面分泌物ESBLs阳性率(62.50%)较高;1236株肺炎克雷伯菌检出最多的标本分别为痰液(32.85%),咽拭子(26.38%),脓液(15.86%),1236株肺炎克雷伯菌ESBLs阳性株549株,阳性率44.42%,其中以血液ESBLs阳性率(57.45%)、积液ESBLs阳性率(50.00%)较高。大肠埃希菌ESBLs阳性株科室分布以泌尿科(22.69%)、ICU(19.62%)、肿瘤科(12.83%)较高;肺炎克雷伯菌科室分布以呼吸内科(30.05%)、泌尿科(19.67%)、ICU(15.85%)较高。耐药分析:大肠埃希菌、肺炎克雷伯菌ESBLs阳性株对阿米卡星、环丙沙星、左氧氟沙星、头孢吡肟、头孢哌酮\舒巴坦、哌拉西林\他唑巴坦、妥布霉素耐药率均高于ESBLs阴性株,差异有统计学意义(P<0.05)。结论肠杆菌科ESBLs阳性菌株的产生、耐药率上升以及多重交叉耐药的普遍性给临床的治疗带来极大的困难,抗生素的合理使用有重要的临床意义。Objective To study the clinical distribution and drug resistance of Escherichia coli and Klebsiella pneu- moniae,and provide clinical reference for clinical rational drug use. Methods The biological Melly VITEK2COMPACT automatic microorganism analyzer on January 2016 to January 2017 in our hospital all kinds of isolates of Escherichia coli and Klebsiella pneumoniae were identified and the drug sensitivity analysis. Results The specimens of Escherichia coli was the most of 1920 strains were urine （38.28%）,（29.11%） sputum,pus （11.15%） detected more,1920 strains of Escherichia coli Coli ESBLs 943 positive strains, the positive rate was 49.11%, the positive rate of ESBLs effusion （64.44%） ,the positive rate of wound secretion of ESBLs （62.50%） high; 1236 strains of Klebsiella pneumoniae were detected in most of the specimens were sputum （32.85 %）, pharynx （26.38 % ）, pus （ 15.86 % ）, 1236 strains of Klebsiella pneumoniae ESBLs 549 positive strains, the positive rate was 44.42%, among which the blood ESBLs positive rate （57.45%）,the positive rate of ESBLs （50%）. Higher ESBLs positive strains of Escherichia coli; distribution of departments in urology （22.69 % ）, ICU （19.62 % ）, oncology （12.83 % ） high; Klebsiella pneumoniae clinical distribution in the respiratory department （ 30.05 % ）, urology （ 19. 67 %）, ICU （ 15.85 % ） ; high; drug resistance analysis of Escherichia coli,Klebsiella pneumoniae Klebsiella pneumoniae ESBLs positive strains to Amikacin,ciprofloxacin,levofloxacin,cefepime,cefoperazone sulbactam, piperacillin tazobactam, tobramycin resistance rate was higher than that of ESBLs negative strains,the difference was statistically Significance （P〈0.05）. Conclusion Enterobacteriaceae ESBLs positive strains,the resistant rate of rise and universal multiple cross resistance to clinical treatment brings great difficulties,has important clinical significance in the rational use of antibiotics.

关 键 词：大肠埃希菌 肺炎克雷伯菌 分布 耐药 

分 类 号：R446.5[医药卫生—诊断学]