绍兴市老年医院近2年肺炎克雷伯菌的耐药性分析

Drug resistance of klebsiella pneumoniae in geriatric hospital in Shaoxing in recent two years

目的收集绍兴市老年医院2008年1月-2009年10月临床分离的肺炎克雷伯菌,了解其分布及耐药情况,为临床合理使用抗菌药物提供依据。方法药敏试验采用微量稀释法,产超广谱β-内酰胺酶(ESBLs)细菌检测采用纸片确证试验。结果 196株肺炎克雷伯菌主要来源于痰液和尿液标本;科室分布以呼吸科I、CU、老年病房最为常见;肺炎克雷伯菌产ESBLs阳性率为40.3%,该菌株对亚胺培南和美罗培南均100.0%敏感,对阿莫西林、替卡西林、头孢呋辛和头孢噻吩均100.0%耐药,对其他抗菌药物具有较高的耐药性;117株产ESBLs阴性菌对抗菌药物的耐药性较低,与79株产ESBLs阳性菌比较,差异有统计学意义(P<0.01)。结论医院产ESBLs的肺炎克雷伯菌耐药性严重,应加强肺炎克雷伯菌产ESBLs的发生及其对抗菌药物耐药性检测和监测,预防耐药菌株的流行。

OBJECTIVE To collect of Klebsiella pneumoniae in geriatric hospital in Shaoxing from Jan 2008 to Oct 2009,to understand the distribution and drug resistance,to provide the clinical basis for the rational use of antimicrobial agents.METHODS Drug susceptibility test was performed by micro-dilution method,extended spectrum β-lactamases（ESBLs）-producing bacteria were detected by disk confirmation test.RESULTS MostK.pneumoniae isolates were collected from sputum and urine specimens.The department of respiratory,ICU and elderly wards were the most common.ESBLs K.pneumoniae accounted for 40.3%,the strains to imipenem and meropenem 100.0% sensitive to amoxicillin,ticarcillin,cefuroxime,Cefalotin was 100.0% resistant to other antibiotics with higher resistance;The drug resistance of 117 ESBLs-negative bacteria to antimicrobial agents was low,and compared with 79 ESBLs-positive bacteria,the difference was statistically significant（P0.01）.CONCLUSION Court ESBLs producing K.pneumoniae resistance to serious,should be strengthened K.pneumoniae occurrence of ESBLs and their antimicrobial resistance detection and monitoring,prevention of drug-resistant strains of the epidemic.