45株肺炎克雷伯菌下呼吸道感染的耐药分析

Klebsiella pneumoniae in Lower Respiratory Infection:Drug Resistance Analysis of 45 Strains

目的 了解肺炎克雷伯菌产超广谱 β 内酰胺酶 (ESBLs)细菌的发生率和耐药性 ,预防医院感染的暴发流行。方法 收集 2 0 0 3年 3月～ 2 0 0 4年 1月 ,确诊为肺炎克雷伯菌下呼吸道感染的住院患者的临床资料 ,进行回顾性分析。结果 产ESBLs细菌总检出率为 5 5 6 % ,主要分布神经外科、神经内科、胸外科 ;产ESBLs菌株 ,除亚胺培南 /西司他丁敏感率为 95 5 %哌拉西林 /他唑巴坦敏感率 4 1 7%外 ,其他 16种抗菌药物的耐药率高达 70 4 %～10 0 0 % ,非产ESBLs菌株除头孢曲松、亚胺培南 /西司他丁外 ,仅氨苄西林的耐药率为 93 3% ,其余 15种抗菌药物的耐药率为 6 7%～ 4 4 4 % ;产ESBLs菌株可引发医院感染 ,同时大量第三代头孢菌素、激素的使用是造成耐药的主要原因 ,经卡方检验 ,P <0 0 1。结论 合理应用抗菌药物 ,严格执行消毒、隔离制度 ,对降低细菌的产酶率 。

OBJECTIVE To study the frequency and the drug resistance of ESBLs producing Klebsiella pneumoniae, and prevent the outbreak of hospital infection. METHODS The clinical data of inpatients infected by K. pneumoniae in lower respitatory tract from Mar 2003 to Jun 2004 were retrospectively analyzed. RESULTS The total detected rate of bacteria with ESBLs was 55 6%, and the distribution mainly was in departments of neurosurgery, neurology and thoracosurgery. The susceptivity of ESBLs producing was 95 5% for imipenem/cilastatin, and 41 7% for piperacillin/tazobactam, but the drug resistant rate was 70 4 100 0% for other 16 antibiotics in bacteria. The drug resistant rate in ESBLs nonproducing bacteria was 93 3% for ampicillin and 6 7 44 4% for other 15 antibiotic drugs. CONCLUSIONS The reasonable usage of antibiotics and strictly sterilizing isolating rules are very important for reducing the rate of ESBLs producing bacteria and preventing the ourbreak of hospital infection.