肺炎克雷伯菌的临床分布及耐药性分析

Analysis of the Clinical Distribution and Drug Resistance of Klebsiella Pneumoniae

目的:通过实验的方式,熟悉通辽地区革兰氏阴性杆菌中肺炎克雷伯菌产超广谱β—内酰胺酶(ES-BLs)的情况,并初步掌握该种细菌对常用的抗生素耐药状况,为临床合理使用抗生素提供有效的依据.方法:样本采集区间为2012年1月至2012年12月,采集地点为内蒙古民族大学附属医院样本分离出的肺炎克雷伯菌共258株,通过采用双纸片协同扩散法检测革兰氏阴性杆菌产超广谱β—内酰胺酶,并且采用K-B法做药敏试验,对肺炎克雷伯杆菌做具体耐药性分析,最终将分析出的耐药性结果按照世界卫生组织细菌耐药性监测网提供的WHONET5.6软件进行数据统计分析,并根据美国国家临床实验标准化委员会订立的标准(2009年版)做出敏感性和耐药性的分析报告.结果:肺炎克雷伯菌在ICU、呼吸内科、神经外科分布较多.肺炎克雷伯菌及其产酶菌株耐药性强,给临床治疗带来很大麻烦,其中亚胺培南是治疗首选,另外对头孢类复合制剂药物也相对敏感.结论:临床可以使用交叉用药方案,避免耐药菌的出现.

Objective： Through experiment to know the situation of Gram-negative bacilli Klebsiella pneumoniae which producing extended-spectrum β -laetamases （ESBLs） in Tongliao area, to primarily grasp the status of resistant to commonly used antibiotics, and to provide an effective basis for clinical rational use of antibiotics. Methods： 258 strains of Klehsiella pneumoniae were screened out from hospitalized patients in Affiliated Hospital of Inner Mongolia University for Nationalities from January 2012 to December 2012. By using double-disk synergy test to detecte the ESBLs produced by Gram-negative bacilli, applying KB method to do drug susceptibility test, and made a specific analysis of drug resistance for Klebsiella pneumoniae. The resistance results were statistically analyzed according to the software WHONET5.5, which was provided by the bacterial resistance monitoring network of World Health Organization, and the sensitivity and resistance analysis report were maken according to the standard which be set up by National Committee for Clinical Laboratory Standard （2009 edition）. Results： The distribution of Klebsiella pneumoniae in ICU, respiratory medicine, neurosurgery were more. The drug resistance of Klebsiella pneumoniae and its enzyme production strains were strong, which brings a great deal of trouble for clinical treatment, imipenem is the first choice in the treatment of Klebsiella pneumoniae, besides, the strains are also relatively sensitive to cephalosporin compound preparation.Conclusion： The crossover drug programs can be used in clinic to avoid the emergence of resistant bacteria.