基层医院ICU下呼吸道感染肺炎克雷伯菌的耐药性分析

Antimicrobial resistance of Klebsiella pneumoniae causing lower respiratory tract infections in ICU of grass-roots hospital

目的了解肺炎克雷伯菌在医院ICU下呼吸道感染痰标本中的耐药趋势。方法 2008-2011年6月ICU患者痰标本中共检出肺炎克雷伯菌265株,采用法国生物梅里埃公司VITEK-32系统对分离的病原菌进行鉴定及药敏试验,按NCCLS标准分析结果,结果应用Whonet5.3软件进行统计分析。结果近4年医院ICU下呼吸道痰标本分离的肺炎克雷伯菌,对常用抗菌药物耐药率有增高趋势,产ESBLs肺炎克雷伯菌对头孢曲松、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦等抗菌药物耐药率均>85.0%,而非产ESBLs菌株的耐药率均<30.0%;肺炎克雷伯菌对头孢哌酮/舒巴坦、氟喹诺酮类、氨基糖苷类等抗菌药物有较高的敏感性,2011年肺炎克雷伯菌对碳青霉烯类药物的耐药率明显增加。结论肺炎克雷伯菌耐药严重,产ESBLs菌株阳性率较高,临床应重视其流行情况并合理使用抗菌药物。

OBJECTIVE To explore the trend of the drug resistance of Klebsiella pneumoniae causing lower respiratory tract infections in ICU.METHODS A total of 265 strains of K.pneumoniae cultured from sputum samples of the patients in ICU from 2008 to Jun 2011 were collected.VITEK-32 system analyzer was used to identify the isolated stains,the drug susceptibility testing was carried out,statistical analysis of the results was performed with WHONET5.3 software according to NCCLS.RESULTS The antimicrobial resistance rates of K.pneumoniae isolated from the sputum specimens during the past 4 years kept an upward tendency,the drug resistance rates of ESBLs-producing K.pneumoniae to ceftriaxone,ceftazidime,cefepime,and piperacillin/tazobactam were higher than 85.0%,and the resistance rates of non-ESBLs-producing K.pneumoniae was less than 30.0%;K.pneumoniae was susceptible to cefoperazone/sulbactam,fluoroquinolones and aminoglycosides,and the antimicrobial resistance rates of K.pneumoniae to carbapenems increased significantly in 2011.CONCLUSION The drug resistance of K.pneumoniae is serious,the isolation rate of ESBLs-producing K.pneumoniae is high,attention should be paid to the spread of those isolates so as to use antibiotics reasonably.