产超广谱β-内酰胺酶肺炎克雷伯菌的耐药性及产酶因素分析

Drug resistance of extended spectrum β-lactamase-producing Klebsiella pneumonia and factors associated with producing β-lactamase

目的分析医院产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药性及其产酶因素,为指导临床合理用药提供参考。方法收集医院2011年住院患者不同标本的肺炎克雷伯菌162株,进行耐药性检测和产ESBLs菌株的确认,采用t检验、χ2检验及多因素logistic回归进行分析。结果 162株肺炎克雷伯菌中,检出产ESBLs肺炎克雷伯菌65株,检出率40.1%;所有产ESBLs肺炎克雷伯菌对亚胺培南敏感,耐药率为0,产ESBLs肺炎克雷伯菌对常用抗菌药物耐药率普遍高于非产ESBLs;多因素logistic回归分析结果表明仅糖尿病、住院时间、抗菌药物联用及机械通气是造成细菌产ESBLs的危险因素。结论连续使用抗菌药物或使用不当易造成细菌产ESBLs,应及时加强肺炎克雷伯菌中产ESBLs及其对抗菌药物耐药性的检测。

OBJECTIVE To analyze the drug resistance of extended spectrum β-lactamases （ESBLs）-producing Klebsiella pneumoniae and the factors associated with the production of enzymes so as to guide the reasonable clinical use of antibiotics. METHODS Totally 162 strains of K. pneumoniae isolated from different specimens of the hospitalized patients were collected in Jan 2011, then the drug resistance was tested, and the ESBLs-producing strains were identified, the data were analyzed through the t test, chi-square test, and the multivariate logistic regression. RESULTS Of totally 162 strains of K. pneumoniae, 65 strains of ESBLs-producing K. pneumoniae were detected with the detection rate of 40.1%. All the ESBLs-producing K. pneumoniae strains were susceptible to imipenem with the drug resistance rate of 0; the drug resistance rate of the ESBLs-producing K. pneumonia was higher than that of the non-ESBLs-producing K. pneumoniae. Multivariate logistic regression analysis showed that the diabetes, length of hospital stay, combination use of antibiotics, and mechanical ventilation were the risk factors associated with the strainst producing ESBLs. CONCLUSION The continuous use of antibiotics or the improp- er use of antibiotics is prone to cause the strainsr producing ＂ESBLs, it is necessary to strengthen the test of drug resistance of ESBLs-producing K. pneumonia.