2016年济南市某儿童医院肺炎克雷伯菌分布特征及耐药性分析  

Analysis on clinical distribution features and drug resistance of Klebsiella pneumoniae in a children's hospital,Jinan city,2016

作　　者：王怀莲[1] 魏小玲[1] 刘延泽[1] 

机构地区：[1]济南市儿童医院,山东济南250022

出　　处：《预防医学论坛》2017年第10期778-781,共4页Preventive Medicine Tribune

摘　　要：目的了解肺炎克雷伯菌在济南市某儿童医院临床各科室送检标本中的分布特征及对常用抗菌药物的耐药特点,指导临床合理使用抗菌药物。方法采用连续监测的形式对922株肺炎克雷伯菌的标本来源、科室分布及耐药性等特征进行动态分析。结果检出产超光谱β内酰胺酶、耐碳青霉烯类肺炎克雷伯菌株各306、56株,标本来源均以痰液(含咽拭子)最多(266、38株),肺泡灌洗液次之(10、7株)。菌株检出排名前3的科室分别是呼吸科(224株)、新生儿科(含新生儿重症监护室)(208株)、儿童重症医学科(152株)。产超光谱β内酰胺酶类肺炎克雷伯菌对碳青霉烯类药物敏感率最高,对氨基糖甙类的敏感性次之,对绝大多数头孢类药物耐药。产碳青霉烯类的肺炎克雷伯菌对碳青霉烯类药物敏感率较低,对林可酰胺类抗菌药物、氨基糖苷类抗菌药物有一定的敏感性。结论临床应加强和规范微生物送检,重视监测产超光谱β内酰胺酶和耐碳青霉烯类肺炎克雷伯菌,在经验性用药的基础上,根据药敏检测结果等检验指标和临床表现及时调整给药方案,促进抗生素的合理应用。Objective To understand the distribution and antimicrobial resistance characteristics of Klebsiella pneumoniae isolates in different clinical departments of a children＇s hospital,Jinan city, so as to provide scientific basis for the clinical rational use of antimicrobial agents. Methods Continuous monitoring was used to analyze the clinical distribution and antimicrobial resistance characteristics of 922 isolates of K. pneumoniaein 2016. Results Totally 306 extended-spectrum-β-1actamase-producing K. pneumoniaeisolates and 56 carbapenemase-producing K. pneumoniae isolates were detected from sputum （pharyngeal swabs） （266 and 38 strains）, followed by the alveolar lavage fluid （ 10 and 7 strains）. The top three departments of the isolates detected were Respiratory Department（224 strains）, Neonatology （including Neonatal Intensive Care Unit）（208 strains）, and Childreffs Pediatric Intensive Care（ 152 strains）. The extended-spectrum-β-lactarnase producing K. pneumoniae had the highest sensitivity rate on carbapenems, some sensitivity on arninoglycosides, and resist- ant on the vast majority of cephalosporins drugs. Carbapenemase-producing K. pneumoniae had low sensitivity on carbap enems,and had certain sensitivity on the amide antibiotics and aminoglycoside antibiotics. Conclusion Microorganism inspection should be strengthened and standardized by clinical physicians,and more attention should be paid to the monito ring of the ESBLs and carbapenern resistant K. pneumoniae;On the basis of the experience administration, the dosage regimen should be adjusted by physicians according to the results of antibacterial sensitive test inspection index and the clinical symptoms, which is useful in promoting the reasonable application of antibiotics.

关 键 词：肺炎克雷伯菌 耐药性 临床分布 儿童医院 

分 类 号：R378.996[医药卫生—病原生物学]