重症监护病房肺炎克雷伯菌耐药分析

Analysis of Antibacterial-Resistance of Klebsiella Pneumoniae in Intensive Care Unit

目的:分析重症监护病房(ICU)肺炎克雷伯菌感染情况及其耐药性演变,为临床合理应用抗菌药物提供依据。方法:2008年—2010年从复旦大学附属金山医院ICU分离出326株肺炎克雷伯菌的药敏实验结果回顾。结果:从ICU分离所得肺炎克雷伯菌的产超广谱β-内酰胺酶(ESBLs)菌株占50.5%～72.0%,显著高于全院水平(37.3%～47.4%)。肺炎克雷伯菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦的耐药率由2008年的0%上升到2010年的18%～23.4%,对头孢吡肟的耐药率由2008年的7.7%上升到2010年的24.3%;泛耐药菌株逐年增加,2008年为0株,2009年为9株,2010年为17株。结论:虽然肺炎克雷伯菌对碳青霉稀类、β-内酰胺酶抑制剂、头孢吡肟有较好的敏感性,但耐药性呈逐年上升趋势。

Objective：Analyze the antibacterial-resistance and the predicament of antibacterial-resistance from klebsiella pneumoniae in ICU to guide rational use of antibacterials.Methods：The antibacterial susceptibility of 326 identified strains of Klebsiella pneumoniae reported by ICU samples in Jinshan Hospital from 2008 to 2010,was retrospectively analyzed.Results：The ESBLs rates of Klebsiella pneumoniae were 50.5%-72.0%in ICU ward,and significantly higher than the average rates of 37.3%-47.4%in all wards.The rates of antibacterial-resistance of klebsiella pneumoniae to imipenem,meropenem,cefoperazone /sulbactam were 0 in 2008,and 18%-23.4%in 2010;to cefepime 7.7%in 2008,and 24.3%in 2010.Pan resistant bacterial strains increase yearly,0 in 2008,9 in 2009,and 17 in 2010.Conclusions：Though klebsiella pneumoniae are rather sensitive to carbapenems,β-lactamase inhibitors,cefepime,the rates of antibacterial-resistance of klebsiella pneumoniae are yearly higher.