肺炎克雷伯菌医院内下呼吸道感染的临床和药敏分析

Hospital acquired infection of low respiratory tract by klebsiella pneumoniae:A clinical and drug sensitivity analysis

目的了解肺炎克雷伯菌(KPN)医院内下呼吸道感染的临床特点、产ESBLs的发生率及对抗菌药物的耐药性。方法回顾性分析2003年11月～2004年12月肺炎克雷伯菌医院内下呼吸道感染38例患者的临床资料及药敏结果。结果年龄>60岁患者占73.7%;患有各种严重基础疾病者占84.2%;使用过广谱抗菌药物者占89.5%;住院时间>20天者占86.8%;接受侵入性操作者占34.2%。临床表现不一。产ESBLs菌占44.7%,主要分布神经外科、呼吸内科、神经内科;产ESBLs菌和非产ESBLs菌均对亚安培南高度敏感,对氨苄西林严重耐药;对其他15种抗菌药物,产ESBLs菌耐药性较非产ESBLs菌显著增高。结论肺炎克雷伯菌医院内下呼吸道感染多发生在有严重基础疾病、免疫功能低下及广谱抗生素的大量使用者;临床表现无特异性;产ESBLs的发生率较高,其耐药性增高,亚安培南为首选的治疗药物。

Objective To investigate the clinical characteristic, the prevalence and resistance of ESBLs-Producing strains in Klebsiella pneumoniae with hospital acquired infection of low respiratory tract. Methods Retrospective analysis of the clinical data of 38 cases with low respiratory tract infection by KPN during November 2003 to December 2004 ,including the drug sensitivity results. Results Among 38 patients 73.7% were more than 60 years old;84.2% had a severe underlying diseases; 89.5% had broad-spectrum antibiotics use for a long time;86.8% had hospitalized more than 20 days; 34.2% had been per-formed invasive operations. The clinical manifestations wasn＇t certain. ESBLs-producing Klebsiella pneumoniae accounted for 44.7% ,and the distribution mainly was in department of neurosurgery, respiratory diseases and neurology. ESBLs-producing becteria and ESBLs-nonproducing bacteria were all susceptible to imipenem, but resistant to Ampicillin, and the resistance of ESBLs-producing bacteria was significantly higher than ESBLs-nonproducing for other 15 antibiotic drugs. Conclusion The main risk factors of low respiratory tract infection by KPN are severe underlying diseases,weakly immunity and long-term inappropriate use of broad-spectrum antibiotics. The clinical manifestations are no characteristic. The incidence of ESBLs-producing strains is high,and the resistance is increasing. Imipenem is prime antibiotics against KPN.