临床分离肺炎克雷伯菌耐药性监测

Surveillance of antimicrobial resistance in clinical isolates of Klebsiella pneumoniae

目的了解临床分离肺炎克雷伯菌的耐药性,为临床合理应用抗菌药物提供实验室依据。方法采用微量稀释法对392例临床分离肺炎克雷伯菌进行药物敏感性测定;超广谱β-内酰胺酶(Extendedspectrumbeta-lactamases,ESBLs)检测用微量稀释法初筛,纸片法做确证试验。结果肺炎克雷伯菌对18种抗菌药物的药敏结果中,耐药率大于30%的抗菌药物多达11种;其中氨苄西林-舒巴坦、氨苄西林、头孢噻吩、哌拉西林、复方新诺明和头孢唑啉的耐药率高达20%以上。耐药率低于10%的抗菌药物仅有4种,分别为头孢曲松(7.7%)、头孢噻肟(7.4%)、氨曲南(6.9%)和亚胺培南(3.1%)。其它抗菌药物的耐药率都高于10%。产ESBLs菌株的发生率为32.9%～45.8%,平均为39.8%;产ESBLs菌株对多种抗菌药物的耐药率显著高于非产ESBLs菌株(P<0.05)。结论临床分离肺炎克雷伯菌对多种抗菌药物的耐药率较高,尤其是产ESBLs菌株的高耐药率及多重耐药性更为明显。临床应加强对肺炎克雷伯菌耐药性的监测并预防耐药菌株的传播流行。

Objective To investigate the resistance in clinical isolates of Klebsiella pneumoniae and offer experimental data for reasonable antimicrobial agents.Methods The microbial sensitivity tests of 392 clinical isolates of Klebsiella pneumoniae were tested by micro-dilution method.Extended spectrum beta-lactamases (ESBLs) were screened by micro-dilution method and confirmed by CAZ+CD2 and CTX+CD3.Results Resistant rates over 30% added up to 11 among the 18 tested antimicrobial agents.Resistant rates of Klebsiella pneumoniae against ampicillin,ampicillin-sulbactam,cephalothin,piperacillin,trimethoprim-sulfamethoxazole,cefacidal,respectively,accounted for more than 50%.Resistance rates of four antimicrobial agents were lower than 10 percentage.They were ceftriaxone (7.7%),cefetaxime (7.4%),aztreonam (6.9%),imipenem (3.1%).Incidences of ESBLs producing strains were from 32.9% to 45.8%.The average was 39.8%.Resistant rates of ESBLs producing strains were much higher than ESBLs nonproducing strains (P<0.05).Conclusions Resistant rates of clinical isolates of Klebsiella pneumoniae were rather high and multidrug-resistance,especially in ESBLs producing strains.We should give more attention to the surveillance of antimicrobial resistance in clinical Klebsiella pneumoniae and prevent transmission and epidemic of those resistant strains.