摘要
目的了解肺炎克雷伯菌（KPN）医院感染的临床分布，以及对抗菌药物的耐药性变迁，为临床合理应用抗菌药物提供依据。方法采用VITEK-2全自动细菌分析系统对2007～2011年全院临床分离的KPN进行药敏试验，用CLSI推荐的方法进行产超广谱β-内酰胺酶（ESBLs）菌株的筛选和确认试验。结果1862株KPN主要来源于痰液，占81．0％；分离率较高的科室是ICU、呼吸内科和肾病科，分别占35．0％、14．0％和11．0％；KPN对β-内酰胺类抗菌药物耐药率较高，均〉50．0％；耐药率较低的是亚胺培南、美罗培南、哌拉西林／他唑巴坦和头孢哌酮／舒巴坦，耐药率为1．6％～13．3％，但亚胺培南和美罗培南耐药率有上升趋势；1862株KPN中产ESBLs菌株检出率为36．6％；产ESBLs菌株除头孢哌酮／舒巴坦和亚胺培南外，对其余抗菌药物的耐药率均明显高于非产酶株（P〈0．05）。结论KPN耐药形势严峻，产ESBLs是KPN耐药和形成多药耐药的主要原因，临床应根据药敏结果合理选用抗菌药物。
OBJECTIVE To understand the clinical distribution of Klebsiella pneumoniae causing nosocomial infections and analyze the change of drug resistance so as to guide reasonable use of uinical antibiotics. METHODS The drug susceptibility testing for the clinical isolates of K. pneumoniae isolated form 2007 to 2011 was performed with VITEK-2 system, then the screening and verification of the extended spectrum β-lactamase（ ESBLs）-producing strains were carried out with methods recommended by CLSI. RESULTS Of totally 1862 strains of K. pneumoniae , 81. 0 % were isolated from the sputum; the isolation rate of the strains was 35. 0 % in ICU, 14.0% in department of respiratory medicine, 11. 0 % in department of nephrology. The drug resistance rate of the K. pneumoniae strains to β-lactams was more than 50. 0%; the drug resistance rate to irnipenern , meropenem, piperacillintazobactam, or cefoperazone-sulbactam varied from 1. 6% to 13. 3%, while the drug resistance rate to imipenem or meropenem had increasing. The rate of the ESBLs-producing strains was 36. 6 %; the drug resistance rate of the ESBLs-producing strains to all the antibiotics was significantly higher than that of the non-ESBLs-producing strains except for cefoperazone-sulbactam and imipenem （P〈0. 05）. CONCLUSION The K. pneumoniae strains are highly resistant to drug, and the production of ESBLs is the leading cause of the drug resistance and the multidrug-resistance in the K. pneumoniae strains; it is necessary for the hospital to reasonably use antibiotics according to the result of drug susceptibility testing.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第5期1073-1075,共3页
Chinese Journal of Nosocomiology
基金
新疆医科大学社科基金项目(2013SKZD02)
关键词
肺炎克雷伯菌
医院感染
分布
耐药性
Klebsiella pneumoniae
Nosocomial infection
Distribution
Drug resistance
