肺炎克雷伯杆菌101株临床分布与耐药性分析

Distribution and drug resistance of 101 strains of Klebsiella pneumoniae

目的分析医院感染肺炎克雷伯杆菌的临床分布及耐药情况,为减少院内肺炎克雷伯菌感染提供理论依据。方法对2011年3月至2012年2月我院临床分离的101株肺炎克雷伯杆菌标本来源临床科室分布及对17种常用抗菌药物的耐药率进行统计;并对菌株进行超广谱β内酰胺酶检测;运用PCR法检测KPC、IMP、VIM及NDM-1耐药基因并测序。结果 101株肺炎克雷伯杆菌标本,来自痰87株,占86.14%;临床科室分布以高干科、神经内科为主各40株,各占39.60%;药敏结果显示我院肺炎克雷伯杆菌对亚胺培南最敏感,敏感率为92.08%;其次是头孢替坦和头孢吡肟,敏感率分别为85.15%及80.20%;产超广谱β内酰胺酶的肺炎克雷伯杆菌70株,检出率为69.31%;耐碳青霉烯类肺炎克雷伯杆菌6株,其中4株检出KPC-2基因,未检出IMP、VIM及NDM-1耐药基因型。结论在我院,产超广谱β内酰胺酶的肺炎克雷伯杆菌检出率较高;肺炎克雷伯杆菌耐碳青霉烯类抗生素可能与携带KPC-2有关,合理使用抗菌药物,以减少耐药菌株的产生。

Objective To analyze the clinical distribution and drug resistance of nosocomial Klebsiella pneumoniae isolates,and to provide reliable evidence for reducing the infection of Klebsiella pneumoniae.Methods 101 strains of clinical separated Klebsiella pneumoniae from March 2011 to February 2012 were collected and counted in specimens,clinical distribution and 17 kinds of commonly used antimicrobial drugs resistance.Detecting extended spectrum β-lactamase,and using Polymerase Chain Reaction（PCR） detect KPC,IMP,VIM,NDM-1 resistant genes and sequencing.Results Of totally 101 strains of Klebsiella pneumoniae,87 （86.14％） were isolated from sputum.40（39.60％）were separatedly obtained from Senior Cadre＇s and neurology department.The antimicrobial susceptibility testing showed that Klebsiella pneumoniae was most sensitive to imipenem（92.08％）,the second was cefotetan （85.15％） and cefepime （80.02％） ; 70 strains produce extended spectrum β-lactamase,accounting for 69.31％.Among 6 strains of carbapenemase resistant KlebsielLa pneumoniae,including 4 strains producing KPC-2 gene,while IPM,VIM and NDM-1 were not found.Condusions In our hospital,the detection rate of Klebsiella pneumoniae which produced extended spectrum β-lactamase is high.Klebsiella pneumoniae resistant to carbapenem antibiotics may be associated with carrying the KPC-2,and the antibiotics should be used reasonably in order to decrease the drug resistant strains.