医院感染肺炎克雷伯菌与鲍氏不动杆菌的分布及耐药性分析

Distribution and drug resistance of Klebsiella pneumoniae and Acinetobacter baumannii causing nosocomial infections

目的探讨医院感染肺炎克雷伯菌和鲍氏不动杆菌的耐药性,旨在降低医院感染率,提高医院感染预防控制措施和治疗水平。方法回顾性分析2009年1月-2011年7月临床各科室送检标本中肺炎克雷伯菌和鲍氏不动杆菌的分离情况及耐药性。结果分离出的1017株病原菌中,肺炎克雷伯菌542株,鲍氏不动杆菌475株,其中送检标本前两位分别是痰液占68.5%和69.9%、血液占14.0%和12.8%;呼吸内科病原菌检出率最高占41.7%和42.9%,其次是ICU占19.7%和17.3%;肺炎克雷伯菌对头孢唑林、哌拉西林、头孢噻肟、头孢呋辛、头孢他啶耐药性较高,耐药率均>35.2%;而肺炎克雷伯菌对亚胺培南和美罗培南耐药率均为0;鲍氏不动杆菌对磺胺甲噁唑/甲氧苄啶、头孢唑林、哌拉西林、头孢呋辛耐药率较高,均>58.7%。结论肺炎克雷伯菌及鲍氏不动杆菌的多药耐药性明显增加,加强预防控制措施及耐药性监测,合理使用抗菌药物,避免病原菌在医院内暴发流行。

OBJECTIVE To explore the drug resistance of Klebsiella pneumoniae and Acinetobacter baumannii causing nosocomial infections so as to reduce the incidence of the nosocomial infections and improve the level of prevention and treatment of nosocomial infections.METHODS The clinical specimens were submitted from various department between Jan 2009 and Jul 2011,and the isolation and drug resistance of the K.pneumoniae and A.baumannii strains were retrospectively analyzed.RESULTS Of totally 1017 strains of pathogens isolated,there were 542 strains of K.pneumoniae and 475 strains of A.baumannii.There were 68.5% of the K.pneumoniae strains isolated from the sputum and 69.9% of the A.baumannii strains isolated from the sputum specimens,and there were 14.0% of the K.pneumoniae strains isolated from the blood and 12.8% of the A.baumannii strains isolated from the blood.The detection rate of the pathogens was the highest in the department of respiratory medicine with 41.7% of the K.pneumoniae strains and 42.9% of the A.baumannii strains,followed by the ICU with 19.7% of the K.pneumoniae strains and 17.3% of the A.baumannii strains.The drug resistance rates of the K.pneumoniae to cefazolin,piperacillin,cefotaxime,cefuroxime,and ceftazidime were more than 35.2% and 0% to imipenem and meropenem.The drug resistance rates of the A.baumannii strains to sulfamethoxazole/trimethoprim,cefazolin,piperacillin,and cefuroxime were higher than 58.7%.CONCLUSION The K.pneumoniae and A.baumannii strains are increased significantly.To strengthen the implementation of the prevention and control measures as well as the monitoring of the drug resistance and to reasonably use antibiotics can avoid the outbreak and prevalence of the pathogens in the hospital.