产KPC酶肺炎克雷伯菌的感染分布特点及中西医药物结合对其的抑制效果  

Characteristics of infection distribution of KPC-producing klebsiella pneumoniae and its inhibitory effect on integrated traditional Chinese medicine and western medicine

作　　者：卢滔[1] 方敏 彭春仙[1] 卢伟力[1] 吴志宇[1] 

机构地区：[1]浙江省衢州市人民医院感染科,浙江衢州324000 [2]浙江省衢州市柯城区人民医院肿瘤内科,浙江衢州324000

出　　处：《中国现代医生》2018年第3期15-18,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目A类一般研究项目(2015KYA234)

摘　　要：目的探讨产KPC酶肺炎克雷伯菌的临床感染分布特点及中西医结合的干预效果。方法收集临床多个科室标本,共筛查出产KPC酶肺炎克雷伯菌株523株,分析其临床分布情况及病区分布情况。将配置好的头孢三嗪、鱼腥草注射液、穿琥宁注射液分别单独或与西药配伍加入适当浓度的产KPC酶肺炎克雷伯菌落中,经动态比浊法测定内毒素含量。结果在临床分离出的523例产KPC酶肺炎克雷伯菌株中,来自于呼吸道标本所占的比率最高,其次为中段尿液、脓液及伤口分泌物、血液。在各标本中产ESBLs阳性率最高的为呼吸道标本,其次为脓液及伤口分泌物、血液、中段尿液。产KPC酶肺炎克雷伯菌的临床病区分布情况:呼吸科所占比率最高,其次为ICU、感染科、泌尿外科。产ESBLs情况也存在明显差异,ICU所占百分比最高,其次为肿瘤科、呼吸科、感染科。鱼腥草组、穿琥宁组及与西药配伍组内毒素产生的量均明显低于西药组(P<0.01)。结论产KPC酶肺炎克雷伯菌的临床分布有一定特点,中药抗菌药物配伍西药对产KPC酶肺炎克雷伯菌内毒素的释放有明显的抑制作用。Objective To investigate the characteristics of infection distribution of KPC-producing Klebsiella pneumo- niae and its intervention effect of integrated traditional Chinese and western medicine. Methods A total of 523 strains of KPC-producing Klebsiella pneumoniae were screened from various clinical departments, and its clinical distribution and distribution of disease areas were analyzed. Ceftriaxone, Houttuynia injection, and Chuanhuning injection which were well-prepared were added into appropriate concentration of KPC-produing Klebsiella pneumoniae colony alone or combined with western medicine. The endotoxin content was determined by dynamic turbidimetry. Results In the clini- cally isolated 523 cases of KPC-producing Klebsiella pneumoniae strains, the highest proportion was from respiratory specimens, followed by the middle segment of urine, pus, wound secretions, blood. The highest ESBLs-producing posi- tive rate in each specimen was from respiratory specimens, followed by pus, wound secretions, blood, middle segment of urine. The distribution of clinical ward of KDS-producing Klebsiella pneumoniae： Respiratory rate accounted for the highest rate, followed by ICU, department of infectious diseases, and urology. ESBLs production was significantly differ- ent. ICU accounted for the highest percentage, followed by the Department of Oncology, Respiratory Medicine, and In- fectious Diseases. The amount of endotoxin produced in Houttuynia group, Chuanhuning group and integrated western medicine group was all significantly lower than that in western medicine group（P〈0.01）. Conclusion The clinical distri- bution of KPC-producing Klebsiella pneumoniae has certain characteristics. Anti-bacterial Chinese medicine combined with Western medicine has a significant inhibitory effect on the release of endotoxin in KPC-producing Klebsiella pneumoniae.

关 键 词：肺炎克雷伯菌 肺炎克雷伯菌耐碳青霉烯酶 内毒素 感染 

分 类 号：R446.5[医药卫生—诊断学]