2008-2012年484株肺炎克雷伯菌耐药性分析及耐药机制的初步研究

The drug resistance and mechanism of 484 strains of Klebsiella pneumonia during 2008 to 2012

目的回顾性分析近五年来医院住院及门诊病原菌感染患者中肺炎克雷伯菌的分离趋势,探讨其对常规抗菌药物的耐药性变迁和相关耐药机制。方法采用法国梅里埃公司的Vitek-2 Compact全自动微生物分析仪进行细菌鉴定及药敏试验,部分菌株采用微量生化管鉴定,部分药敏试验采用琼脂扩散法(KB),药敏结果判读按照美国临床和实验室标准化协会(CLSI)制定的标准判读,纸片法表型确证试验检测超广谱β-内酰胺酶(ESBLs),改良Hodge试验检测碳青霉烯酶表型,EDTA双纸片法检测金属酶表型。结果五年间484株肺炎克雷伯菌部分药物耐药率正逐年上升,其常见药物平均耐药率如下:阿米卡星(3.0%),复方新诺明(31.1%),头孢三嗪(14.5%),环丙沙星(18.7%),氯霉素(21.6%),特治星(6.3%),头孢他啶(22.0%),头孢噻肟(23.6%),舒普深(4.2%),呋喃妥英(26.9%),美罗培南(2.1%),ESBLs阳性99株(20.4%),改良Hodge试验检测碳青霉烯酶表型阳性5株,EDTA双纸片法检测金属酶表型阳性2株。结论部分药物耐药率逐年上升的有复方新诺明、环丙沙星、头孢他啶、头孢噻肟;耐药率较低的有美罗培南、阿米卡星、舒普深、特治星、头孢三嗪。应加强细菌耐药性监测,以及耐碳青霉烯酶筛查试验,为临床提供用药参考。

Objective To analyze the changes in drug resistance and mechanism of Klebsiella pneumoniae to conanonly used antibacterial drugs in recent five years. Methods The bacterial identification and the antimicrobial susceptibility tests were performed by using automatic microbial analyzer Vitek-2 Compact （Merieux, France）, microbiochemical tube identification and agar spread plate method （K-B）. Interpretation of drug resistance results was in accordance with Unit- ed States Clinical and Laboratory Standards Institute （CLSI）. Extended-spectrum 13-Lactamases （ESBLs） were detected with phenotypic confirmatory test. Carbapenemase was confirmed by modified Hodge test. Metalloenzyme was confirmed by EDTA double disk diffusion test. Results The resistance rates of the 484 strains of Klebsiella pneumonia to some drugs were increasing during the five years： Amikacin （3%）, compound SXT （31.1%）, Ceflriaxone （14.5%）, Ciproloxacin （ 18.7% ）, Chloramphenicol （21.6%）, Piperacillin/Tazobactam （6.3%）, Ceftazidime （22.0%）, Cefotaxime （23.6%）, Cefoperazone sodium/sulbactam （4.2%）, Nitrofurantoin （26.9%）, and Meropenem （2. l% ）. 99 strains（20.4%） were ESBLs positive, 5 strains were carbapenem enzyme positive, and 2 strains were metalloenzyme positive. Conclusion The resistance rates of Klebsiella pneumonia isolated in our hospital to some drugs are increasing year by year, including compound SXT, Ciproloxacin, Ceftazidime and Cefotaxime, while the resistance rates to meropenem, Amikacin, Cefoperazone sodium/sulbactam, Piperacillin/Tazobactam and Ceftriaxone are lower. The monitoring of bacterial resistance should be strengthened, and carbapenems resistance screening test should be conducted to provide reference for clinical use of drugs.