2015至2017年山东省立医院肺炎克雷伯菌的分布及耐药性变化分析  

Changes of distribution and antimicrobial resistance of klebsiella pneumoniae in Shandong Provincial Hospital from 2015 to 2017

作　　者：吴东芹 刘海燕[2] Wu Dongqin;Liu Haiyan(Department of Pediatrics,Yucheng Hospital of Traditional Chinese Medicine,Shandong Province,Yucheng 251200,China;Department of Pediatric Intensive Care Medicine,Provincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东省禹城市中医院儿科,251200 [2]山东大学附属省立医院小儿重症医学科,济南250021

出　　处：《中国小儿急救医学》2019年第5期348-352,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的了解山东省立医院近3年肺炎克雷伯菌的分布及耐药情况,为临床经验治疗提供参考。方法对我院2015年1月1日至2017年12月31日期间收集的标本进行细菌学培养。采用纸片扩散法或自动化仪器法按统一方案进行药物敏感性试验。按CLSI 2014版标准判断结果。结果2015至2017年全院细菌培养送检标本共79 615份,分离肺炎克雷伯菌株(非重复菌)共2 159株,分离率分别为9.87%、9.23%、9.98%。产超广谱β-内酰胺酶(extended spectrum β-lactamase,ESBLs)肺炎克雷伯菌株检出率依次为37.97%、43.57%和40.87%。标本主要分离自痰、血、尿液、皮肤软组织、腹水及脑脊液等。除了2017年痰培养标本中肺炎克雷伯菌产ESBLs率略有下降外,其他标本都呈现逐年递增的趋势,血培养标本尤为明显,其产ESBLs肺炎克雷伯菌阳性率由2015年的24.53%上升到2017年的55.00%。产ESBLs株对各种抗菌药物耐药率均显著高于非产ESBLs株。产ESBLs肺炎克雷伯菌对大多数抗菌药物有较高的耐药率,对碳青霉烯类药物最敏感,耐药率均低于17%,但是碳青霉烯类药物的耐药率呈迅速上升趋势。结论肺炎克雷伯菌是临床常见的致病菌,产ESBLs菌株耐药率高,碳青霉烯耐药的产ESBLs株也在急剧增多,耐药率上升。加强细菌耐药性监测及感染控制措施对于细菌感染的有效治疗十分重要。Objective To investigate the antimicrobial resistance and distribution of klebsiella pneumoniae in Shandong Provincial Hospital and to provide a reference for clinical treatment. Methods The specimens collected in our hospital from January 1, 2015 to December 31, 2017 were cultured.The drug sensitivity test was carried out according to the unified scheme by paper diffusion method or automated instrument method.The results were interpreted according to the CLSI 2014 M100-S24, and the data were analyzed by using WHONET5.6 software. Results From 2015 to 2017, a total of 79 615 specimens were sent to the hospital for bacterial culture, and 2 159 strains of klebsiella pneumoniae (non-repeat bacteria) were isolated, with a separation rate of 9.87%, 9.23% and 9.98%, respectively.The detection rates of extended spectrum β- lactamase(ESBLs)-producing klebsiella pneumoniae strains were 37.97%, 43.57% and 40.87% respectively.The specimens were mainly separated from sputum, blood, urine, skin soft tissue, ascites and cerebrospinal fluid.Except for the slight decrease in ESBLs-producing rate of klebsiella pneumoniae in sputum culture specimens in 2017, other specimens showed an increasing trend year by year, especially in blood culture specimens.The ESBLs production rate of klebsiella pneumoniae increased from 24.53% in 2015 to 55.00% in 2017.The drug resistance rate of ESBLs-producing strains to various antibacterial drugs was significantly higher than that of non-ESBLs producing strains.ESBLs-producing klebsiella pneumoniae had a high drug resistance rate to most antibiotics, and it was most sensitive to carbapenems, with drug resistance rates lower than 17%.However, the rate of carbapenem-resistant showed a rapid rise. Conclusion Klebsiella pneumoniae is a common pathogenic bacteria in clinical practice, and the drug resistance rate of ESBLs producing strains is high.Strengthening the monitoring of bacterial resistance and infection control measures are very important for the effective treatment of bacterial infection.

关 键 词：肺炎克雷伯菌 耐药性 碳青霉烯耐药 

分 类 号：R446.5[医药卫生—诊断学]