血液分离的肺炎克雷伯菌的患者疾病类型及耐药谱分析

The disease patterns of the patients with bloodstream infection caused by Klebsiella pneumonia and antimicrobial resistance profiles of Klebsiella pneumonia isolates

目的调查血液分离的肺炎克雷伯菌的耐药谱。方法收集温州医学院附属第一医院2005年1月至2009年9月间血液分离的肺炎克雷伯菌,采用全自动微生物分析仪对肺炎克雷伯菌进行菌种鉴定和药敏试验,超广谱β-内酰胺酶的检测采用仪器法。舒普深和美洛培南的药敏试验采用K-B法。结果 80株分离自血液的肺炎克雷伯菌主要分离自患有肝胆疾病、血液系统疾病、呼吸系统疾病和神经系统疾病的患者,分别占20.0%、17.5%、15.0%和13.7%。80株肺炎克雷伯菌中,10株ESBLs阳性,阳性率为12.5%(10/80)。除肺炎克雷伯菌对氨苄西林100%耐药外,对其他15种被测抗菌药物的耐药率全部低于20%,所有被测菌株对亚胺培南和美洛培南全部敏感,对其他9种抗菌药物的耐药率也低于10%。结论血液分离的肺炎克雷伯菌主要来自患有肝胆疾病、血液系统疾病和神经系统疾病的患者。血液分离的肺炎克雷伯菌的ESBLs检出率非常低,且对常用抗菌药物的耐药率非常低。

Objective To investigate the disease patterns of the patients with bloodstream infection caused by Klebsiella pneumonia and antimicrobial resistance profiles of Klebsiella pneumonia isolates.Methods The K.pneumonia isolates from blood from Jan.2005 to Sep.2009 were collected at the Affiliated Hospital of Wenzhou Medical College.The identification,antimicrobial susceptibility and extended-spectrum β-lactamases（ESBLs） of the K.pneumonia isolates were determined by Full-Automated Microbiology Analyzer.Antimicrobial susceptibility of the isolates against cefoperazone/sulbactam and meropenem was determined by K-B disk diffusion.Results A total of 80 strains of K.pneumonia were isolated from blood of the patients with liver and gut diseases,blood disorders,respiratory system diseases and nervous system diseases,which accounted for 20.0%,17.5%,15.0% and 13.7%,respectively.The positive rate of ESBLs was 12.5%（10/80）.In addition to the 100% of resistance rate to ampicillin,the resistance rate of K.pneumonia to other clinically used antimicrobials were less than 20%.The resistance rates of all tested isolates to 9 antimicrobials were less than 10%,while they were 100% susceptive to impenem and meropenem.Conclusion The majority of K.pneumonias was isolated from the blood of patients with liver and gut diseases,blood disorders,respiratory system diseases and nervous system diseases.The prevalence of ESBLs and antimicrobial resistance among these K.pneumonia isolates were very low.