肺炎克雷伯菌医院感染的临床分布及耐药性分析

Distribution and Drug Resistance of Klebsiella pneumoniae from Clinic

目的了解肺炎克雷伯菌医院感染的临床分布及其耐药现状，为临床合理使用抗菌药物提供依据。方法对近两年临床分离的470株肺炎克雷伯菌，采用K—B法检测其对15种抗菌药物的耐药性，用三维试验检测AmpC酶和ESBLS。结果菌株分离最多的临床科室是ICU和烧伤科，检出率最高的标本是痰液和创面；药敏结果表明，肺炎克雷伯菌对青霉素类，一、二代头孢菌素，喹诺酮类和复方新诺明等药物的耐药率51．1％～88．3％，第三、四代头孢菌素的耐药率为32．6％～40．4％，未发现对美罗培南耐药株，但有2株对亚胺培南耐药；共检出产ESBLs菌152株，检出率32．3％，检出产AmpC酶菌29株，检出率6．2％，其中有21株为同时产ESBLs和AmpC酶。结论下呼吸道感染是肺炎克雷伯菌感染的最常见临床类型，ICU、烧伤科是医院感染的高危病区，肺炎克雷伯菌耐药率日趋严重，应加强实验室检测和信息反馈。

OBJECTIVE To analyze the distribution and drug-resistance of Klebsiella pneumoniae isolated from clinic in the past two years to help doctors to use antibiotic reasonably. METHODS To detect the drug-resistance of 470 strains of K. pneurnoniae to 15 kinds of antimicrobial agents were detected by K-B method, and the AmpC β- lactamase and ESBLs were detected through the way of 3-D test. RESULTS ICU and burn department were found where had the highest isolation rate, and sputum and wound that had the highest detection rate. Sensitivity test results showed that the resistance rate of K. pneumoniae to penicillins, first and second-generation cepholospor- ins, fluoroquinolones and sulfamethoxazole compound was high （51.1--88.3 %）, and resistance rate to the third and fourth-generation cephalosporins was high, too（32.6--40.4%）. All strains were sensitive to imipenem, but two of them were resistant to meropenem. ESBLs were found in 152 strains, the detection rate was 32. 3%, AmpC was found in 29 strains, the detection rate was 6. 20%. Both of them were found out in 21 strains. CONCLUSIONS The lower respiratory tract infection is the most common one. The ICU and wound ward are the high-risk places ward of infection. Detection rate and drug resistance are increasingly severe, clinic and laboratory should make concerted efforts to reduce nosocomial infection and strengthen information feedback.