1419株肺炎克雷伯菌分布特点及耐药性分析

Analysis of clinical distribution and drug resistance of 1419 Klebsiella pneumoniae strains

目的：调查我院肺炎克雷伯菌的临床分布及耐药特点。方法：对我院2008年-2011年临床分离的1419株肺炎克雷伯菌进行分析。结果：肺炎克雷伯菌主要分离自重症监护室350株，神经外科142株及呼吸内科129株，最多的系来自痰液标本，有755株，其次是血液124株和尿液106株；4年产超广谱β-内酰胺酶率达48．8％，对常用抗菌药物均产生了不同的耐药性，对氨苄西林100％耐药，头孢菌素耐药率很高（47．7％～60．8％）；氨基糖苷类中庆大霉素耐药率较高（39．4％～44．8％），而阿米卡星及妥布霉素较低（8．0％～22．9％）；氟喹诺酮类耐药率较低（26．7％～40．0％）；哌拉西林／他唑巴坦、头孢替坦等耐药率很低（3．4％～7．8％）；对碳青酶烯类仍呈高度敏感，产碳青霉烯酶（KPC酶）株检出率为0．5％～4．3％。结论：肺炎克雷伯菌感染比较集中于呼吸道，耐药性严重。

Objective： To study the distribution and drug resistance of Klebsiella pneumoniae in this hospital. Methods： A total of 1419 K. pneumoniae isolates from Jan. 2008 to Dec. 2011 in Sun Yat- Sen Memorial Hospital were analyzed. Results： There were 350 K. pneumoniae isolates from intensive care unit, 142 strains from neurosurgery department and 129 strains from respiratory department. Most of the isolates were isolated from sputum（755 strains）, followed by blood （124 strains） and urine （106 strains）. The total incidence of extended spectrum β- lactamase （ESBLs） producing strains was 48.8% （492/1419） in four years. K. pneumoniae was resistant to most antimicrobial agents, with high drug resistance rate to ampicillin （100%）, cephalosporin （47.7% -60.8% ） and gentamicin （39.4% -44.8% ）, but lower resistance to amikacin and tobramycin （8.0% -22.9% ）, fluoroquinalone （26.7% - 40% ）, piperacillinta/zobactam and cefotetan （3.4% - 7.8% ）, respectively. K. pneumoniae were highly sensitive to carbapenems, and the total detection rate of KPC lactamase producing strains was 0.5% - 4.3 %. Conclusion： K. pneumoniae infection was mainly found in respiratory tract in clinic, with serious drug re- sistance.