碳青霉烯类药物耐药的肺炎克雷伯菌分布及耐药分析  

Distribution and drug resistance analysis of carbapenems drug resistant Klebsiella pneumoniae

作　　者：刘景武[1] 严丽 张蕊[1] 崔伟波 孙文泽[1] 董佳[1] 任天红[1] LIU Jingwu;YAN Li;ZHANG Rui;CUI Weibo;SUN Wenze;DONG Jia;REN Tianhong(The Third Hospital of Shijiazhuang,Hebei 050001,China;不详)

机构地区：[1]石家庄市第三医院,河北050001 [2]河北医科大学第三医院

出　　处：《医学动物防制》2020年第11期1078-1080,共3页Journal of Medical Pest Control

基　　金：河北省重点研发计划项目(18227127D);石家庄市科学技术研究与发展指导计划项目(171461543)。

摘　　要：目的确定碳青霉烯类耐药的肺炎克雷伯菌在医院科室的分布情况,指导临床感染控制工作,防止在科室间传播。同时指导临床合理用药,减少病人住院费用,降低病死率。方法收集2016-2018年石家庄市第三医院临床标本中分离的非重复碳青霉烯类耐药肺炎克雷伯菌276株,对其标本来源进行回顾性分析。采用半定量肉汤稀释法进行体外药敏试验,并用mCIM试验检测KPN中的碳青霉烯酶。结果2016-2018年从临床标本中共分离出276株碳青霉烯类耐药肺炎克雷伯菌,其中从痰液中分离出231株、清洁中段尿中分离出24株、血液标本中分离出13株、脓液中分离出1株、伤口引流液分离出1株、腹水中分离出1株、伤口分泌物中分离出1株、静脉留置管管头分离出4株。从科室分布来看,主要集中在ICU病房、干部保健科病房、呼吸内科病房、神经外科病房、肾内科病房。对多粘菌素B、米诺环素敏感率为100.0%,复方新诺明敏感率为1.8%,阿米卡星敏感率为5.0%。结论从临床标本中分离出的碳青霉烯类耐药肺炎克雷伯菌表现出高度的耐药性,临床和感控应引起高度重视。Objective To understand the distribution of carbapenems drug resistant Klebsiella pneumoniae in departments of hospital,provide guidance for control work of clinical infection to avoid the spread of infection among departments,and to guide rational clinical medication in order to reduce hospital costs and fatality rate.Methods Totally 276 strains of Klebsiella pneumoniae isolated from clinical specimens of The Third Hospital of Shijiazhuang from 2016 to 2018 were collected.The retrospective analysis was conducted on the source of samples.The semi-quantitative broth dilution method was used to carry out the vitro drug sensitivity test,and carbapenems in KPN was detected by mCIM test.Results A total of 276 strains were isolated from clinical specimens of carbapenems drug-resistant Klebsiella pneumoniae from 2016 to 2018,with 231 strains isolated from sputum,24 strains isolated from urine,13 strains isolated from the blood samples,1 strain isolated from the pus,1 strain isolated from wound drainage fluid,1 strain isolated from the ascites,1 strain isolated from the wound secretion and 4 strain isolated from venous catheter.From the perspective of department distribution,Klebsiella pneumoniae was mainly concentrated in ICU ward,cadre health ward,respiratory ward,neurosurgical ward and nephrology ward.The sensitivity rates of Klebsiella pneumoniae to polymyxin B and minocycline were 100.0%,while those to compound sulfamethoxazole and amikacin were 1.8%and 5.0%,respectively.Conclusion Carbapenems drug-resistant Klebsiella pneumoniae isolated from clinical specimens showed a high level of drug resistance.Therefore,it should be highlighted in clinical practice and infection control.

关 键 词：碳青霉烯类药物 耐药 肺炎克雷伯菌 分布 耐药分析 

分 类 号：R378.996[医药卫生—病原生物学] R978.1[医药卫生—基础医学]