医院感染肺炎克雷伯菌的分布及耐药性分析

Distribution and drug resistance of klebsiella pneumoniae causing nosocomial infections

目的探讨医院感染肺炎克雷伯菌（KPN）在临床标本中的分布及耐药性,为临床医师合理用药提供科学依据。方法采用微量稀释法对临床送检标本分离的KPN进行药敏试验,分析其耐药性。结果 420株KPN主要分布在重症监护病房（ICU）、呼吸内科、普外一科、中医康复科和内分泌科等科室;主要来源于痰液,占49.5%;KPN对亚胺培南的敏感率为98.6%,对哌拉西林/他唑巴坦、阿莫西林/克拉维酸、头孢西丁、头孢吡肟、头孢他啶、左氧氟沙星、氨曲南、加替沙星、庆大霉素等的耐药率为70.0%~89.0%,对替卡西林/克拉维酸、妥布霉素、环丙沙星、头孢噻肟、头孢曲松、头孢唑林、氨苄西林/舒巴坦、头孢呋辛、四环素、哌拉西林、头孢噻吩、甲氧苄啶、呋喃妥因等的敏感率为30.0%~69.0%;对氨苄西林的敏感率仅为4.8%;24种抗菌药物药敏试验中,8种药物敏感率略微上升,13种药物敏感率略微下降,3种药物敏感率下降较多。结论医院肺炎克雷伯菌耐药控制较好,临床应继续根据药敏结果合理使用抗菌药物。

OBJECTIVE To investigate the distribution and drug-resistance of Klebsiella pneumoniae（KPN） in nosocomial infections to provide the scientific evidence for the clinical use of the antibiotics.METHODS The drug sensitive test was performed by broth microdilution test and the drug resistance was analyzed.RESULTS A total of 420 KPN strains were mainly isolated from intensive care unit（ICU）,departments of respiratory medicine,general sugery,rehabilitation and neurology,and so on;the KPN strains were mainly isolated from sputum（about 49.5%）.The sensitive rate of KPN to imipenem was 98.6%;the drug resistance rates of KPN to piperacillin/tazobactam,amoxicillin/clavulanic acid,cefoxitin,cefepime,ceftazidime,levofloxacin,aztreonam,gatifloxacin and gentamicin were 70.0%～89.0%;and the sensitive rates of KPN to Ticarcillin/clavulanic acid,tobramycin,ciprofloxacin,cefotaxime,ceftriaxone,cefazolin,ampicillin/sulbactam,cefuroxime,tetracycline,piperacillin,cefalotin,trimethoprim and nitrofurantoin were 30.0%～69.0%;the sensitive rate to ampicillin was 4.8%;the drug sensitivity tests of 24 kinds of antibiotics showed that the drug sensitive rates to 8 kinds of antibiotics were slightly increased,to 13 kinds of antibiotics were slightly decreased and the sensitive rates of KPN to 3 kinds of antibiotics were in a little more downtrend.CONCLUSION Drug resistance status of KPN is well controlled.The clinician should continue to use antibiotics rationally according to the results of drug susceptibility test.