医院感染肺炎克雷伯菌与大肠埃希菌的分布差异及耐药分析  

Distribution difference and drug resistance analysis of hospital infection of Klebsiella pneumoniae and Escherichia coli

作　　者：郑港森[1] 江素香 逯晓辉[1] 练明建 ZHENG Gang-sen;JIANG Su-xiang;LU Xiao-hui;LIAN Ming-jian(Clinical Laboratory,the First Affiliated Hospital of Xiamen University,Xiamen Key Laboratory of Genetic Testing,Fujian Province,Xiamen 361003;Clinical Laboratory,Zhongshan Hospital Affiliated to Xiamen University,Fujian Province,Xiamen 361004)

机构地区：[1]厦门大学附属第一医院检验科厦门市基因检测重点实验室,福建厦门361003 [2]厦门大学附属中山医院检验科,福建厦门361004

出　　处：《中国当代医药》2021年第35期187-191,共5页China Modern Medicine

基　　金：厦门大学附属第一医院青年科研发展基金资助项目(XYY2017012)。

摘　　要：目的比较分析临床分离大肠埃希菌和肺炎克雷伯菌之间的差异性,包括敏感性、标本类型分离和科室分布情况等,及时充分了解当前这两种主要病原菌耐药情况。方法采用法国BioMerieux VITEK2 Compact全自动细菌鉴定及药敏分析系统对菌株进行细菌鉴定和药物敏感性检测,并用Excel软件进行数据分析。结果2020年临床分离大肠埃希菌1614株,肺炎克雷伯菌579株,大肠埃希菌尿液分离菌株占一半以上,而肺炎克雷伯菌不同标本分离菌株相差不大;呼吸道标本肺炎克雷伯菌分离数量大于大肠埃希菌;重症加强护理病房(ICU)中两者分离菌株相差不大,而其它科室分离相差较大;两者产超广谱β-内酰胺酶(ESBLs)菌株检出率比较,差异有统计学意义(P<0.05),ESBLs(-)菌株检出率比较,差异无统计学意义(P>0.5)。大肠埃希菌对亚胺培南的敏感率为98.9%,而肺炎克雷伯菌为82.4%,尤其在ICU,其敏感率低至59.5%。痰液分离肺炎克雷伯菌对亚胺培南的敏感率为64.8%。102株耐亚胺培南肺炎克雷伯菌中有4株对氨曲南敏感,而17株耐亚胺培南大肠埃希菌中对有10株氨曲南敏感。结论大肠埃希菌和肺炎克雷伯菌均出现对碳青霉烯类抗菌药物耐药菌株,尤其是肺炎克雷伯菌上升明显,而且两者产碳青霉烯酶的类型有所区别。肺炎克雷伯菌对大多数抗菌药物敏感性比大肠埃希菌低,除左氧氟沙星相对较好;ICU耐药问题尤其严重,全血分离菌株敏感性较好,而痰液分离菌株敏感性较差。Objective To compare and analyze the differences between clinical isolates of Escherichia coli and Klebsiella pneumoniae,including sensitivity,specimen type separation and department distribution,so as to fully understand the drug resistance of the two main pathogens.Methods BioMerieux VITEK2 Compact automatic bacterial identification and drug sensitivity analysis system were used for bacterial identification and drug sensitivity test,and Excel software was used for data analysis.Results In 2020,1614 strains of Escherichia coli and 579 strains of Klebsiella pneumoniae were clinically isolated,and more than half of them were isolated from urine,but there was no significant difference among different samples of Klebsiella pneumoniae.The number of Klebsiella pneumoniae isolated from respiratory tract samples was much more than that of Escherichia coli.There was no statistically significant difference between the two isolates in intensive care unit(ICU),but there was statistically significant difference in other departments.There was statistically significant difference in the detection rate of ESBLs(-)strain between the two strains(P<0.05),but there was no statistically significant difference in the detection rate of ESBLs(-)strain(P>0.5).The susceptibility rate of Escherichia coli to imipenem was 98.9%,while that of Klebsiella pneumoniae was 82.4%,especially in ICU,the susceptibility rate was as low as 59.5%.The susceptibility rate of Klebsiella pneumoniae isolated from sputum to imipenem was 64.8%.Four out of 102 strains of Imipenam-resistant Klebsiella pneumoniae were susceptible to tronem,while 10 out of 17 strains of imipenam-resistant Escherichia coli were susceptible to tronem.Conclusion Both Escherichia coli and Klebsiella pneumoniae are resistant to carbapenems,especially Klebsiella pneumoniae,and their carbapenemase producing types are different.Klebsiella pneumoniae is less sensitive to most antibiotics than Escherichia coli,except levofloxacin.The drug resistance problem is particularly serious in ICU,an

关 键 词：大肠埃希菌 肺炎克雷伯菌 超广谱Β-内酰胺酶 AMPC酶 碳青霉烯酶 

分 类 号：R446.5[医药卫生—诊断学]