佛山南海地区肺炎克雷伯菌分布及耐药特征

Characteristics of distribution and antimicrobial resistance of Klebsiella pneumoniae at Nanhai area in Foshan

目的了解2012年我院肺炎克雷伯菌的分布及耐药特征，为临床抗感染治疗和合理选择抗菌药物提供依据。方法采用纸片扩散法进行抗菌药物敏感实验，药敏结果按美国CLS12012版判断标准，WHONET5．4软件及SPSS13．0软件进行数据分析。结果四个季度该菌的构成比分别为9．6％、12：4％、12．4％、12．8％，ESBLs检出率分别为38．2％、24．7％、36．3％、36．9％，产ESBLs菌株耐药率明显高于非产ESBLs菌株，差异具有统计学意义（P〈0．05）。产ESBLs菌株对β-内酰胺加酶抑制剂的复合抗生素的敏感性下降。结论本地区肺炎克雷伯菌呈高分布状态，产ESBLs株高流行，整体呈上升趋势，经验性治疗可首选碳青霉烯类，β-内酰胺加酶抑制剂的复合抗生素也可优先选择。加强细菌耐药监测对抗菌药物的临床合理应用和控制细菌耐药性传播具有重要意义。

Objective To investigate the characteristics of distribution and antimicrobial resistance of Klebsiella pneumoniae in our hospital in 2012. Methods Disk diffusion antibiotic sensitivity testing was used to determine antimicrobial susceptibility, and the results were judged according to the American CLSI2012 standard. The WHONETS.4 software and the SPSS13.0 software were used to analyze the data. Results Of all clinical isolates, Klebsiella pneumoniae strains accounted for 9.6%, 12.4%, 12.4%, and 12.8%; and the rate of ESBLs was 38.2%, 24.7%, 36.3%, and 36.9% in the four quarters, respectively. The rate of antimicrobial resistance for the ESBLs- producing strains was higher than those without ESBLs, with statistical difference （P〈0.05）. The susceptibility of ESBLs-producing strains to antibiotics with beta-lactamase inhibitor decreased. Conclusions Klebsiella pneumoniae distributed widely and ESBLs-producing strains were highly prevalent in Nanhai area, with a rising tendency. Carbapenems can be the first choice for the empirical treatment of ESBLs-producing strains, and antibiotics with beta-lactamase inhibitor can also be used. Intensified surveillance of bacterial resistance is of important significance for rational clinical uses of antibacterials and for the control of spread of the drug-resistance bacteria.