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

目的了解医院2004-2008年临床感染肺炎克雷伯菌分布状况和耐药趋势,指导临床合理应用抗菌药物。方法回顾性分析医院2004-2008年临床分离肺炎克雷伯菌的临床分布及耐药性;采用VITEK-32全自动细菌鉴定仪;药物敏感试验采用K-B纸片扩散法,用双纸片协同试验进行超广谱β-内酰胺酶(ESBLs)检测。结果1598株肺炎克雷伯菌主要来源于痰液标本和中段尿标本,两者分别占肺炎克雷伯菌检出率的72.4%和20.0%;产超广谱β-内酰胺酶(ESBLs)菌株近5年无显著变化,对一～三代头孢菌素耐药率一直很高;对碳青霉烯类抗菌药物总体上有较高的敏感性,但耐药率也在逐年上升。结论医院临床分离的肺炎克雷伯菌对碳青霉烯类抗菌药物耐药性5年呈快速增长趋势,尤其是泛耐药菌株的不断出现,给临床治疗带来了巨大难题,应引起高度重视,以预防医院感染的发生和暴发流行。

OBJECTIVE To get clear information about the distribution and drug resistance tendency of Klebsiella pneumoniae and provide some knowledge for the rational application of antibiotics. METHODS The drug resistance of isolated K.pneumoniae in hospital from 2004 to 2008 was analyzed.VITEK-32 auto-microbial-evaluation instrument was used in evaluation system.Kirby Bauer is adopted in drug sensitivity test and double disk synergy test is utilized in the test of Extended-Spectrumβ-lactamase（ESBLs）. RESULTS A total of 1598 K.pneumoniae come from sputum sample and midstream urine sample,which accounted for 72.4% and 20.0% of the total respectively.There is not prominent change for bacterial strain of Extended-Spectrumβ-lactamase（ESBLs）in recent five years with the 1st,2nd and 3rd generation of cephalosporin remain to have strong drug resistance.Generally,carbapenems antibacterials have relatively high drug sensitivity but the drug-resistance rate is increasing year by year. CONCLUSION The drug resistance of K.pneumoniae isolates in hospital towards carbapenems antibacterials has a rapid increasing tendency during these five years,especially the bacterial strains with pan-drug resistance appear constantly,which bring great challenge to clinical treatment.Therefore,great attention should be paid to prevent the epidemic outbreak of hospital acquired infection.