院内大肠埃希菌和肺炎克雷伯菌的耐药性分析及分布

Antibiotic resistance and distribution of Escherichia coli and Klebsiella, Pneumoniae in hospital

目的了解本院院内大肠埃希菌和肺炎克雷伯菌的耐药性及分布情况,为临床合理使用抗菌药物提供理论依据。方法应用鑫科细菌鉴定仪进行细菌鉴定,采用XK-96A-C药敏板进行药敏试验。结果 2012年10月至2013年8月本院临床共分离34株大肠埃希菌和32株肺炎克雷伯菌。其中34株大肠埃希菌对氨苄西林、哌拉西林、头孢唑林、复方新诺明、头孢呋辛、头孢噻肟、氨曲南、头孢吡肟、洛美沙星、环丙沙星、头孢他啶、庆大霉素、妥布霉素、左氧氟沙星、呋喃妥因、头孢西丁、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南的耐药率依次为70.6%(24/34)、67.6%(23/34)、64.7%(22/34)、58.8%(20/34)、55.9%(19/34)、55.9%(19/34)、52.9%(18/34)、52.9%(18/34)、52.9%(18/34)、50.0%(17/34)、44.1%(15/34)、44.1%(15/34)、38.2%(13/34)、29.4%(10/34)、14.7%(5/34)、11.8%(4/34)、11.8%(4/34)、5.9%(2/34)、2.9%(1/34)和2.9%(1/34)。32株肺炎克雷伯菌对氨苄西林、哌拉西林、呋喃妥因、头孢唑林、头孢呋辛、洛美沙星、庆大霉素、头孢噻肟、头孢吡肟、妥布霉素、环丙沙星、氨曲南、头孢他啶、复方新诺明、阿米卡星、左氧氟沙星、头孢西丁、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南的耐药率依次为100%(32/32)、37.5%(12/32)、31.3%(10/32)、28.1%(9/32)、28.1%(9/32)、25%(8/32)、21.9%(7/32)、21.9%(7/32)、18.8%(6/32)、18.8%(6/32)、18.8%(6/32)、15.6%(5/32)、15.6%(5/32)、15.6%(5/32)、12.5%(4/32)、12.5%(4/32)、9.4%(3/32)、6.3%(2/32)、6.3%(2/32)和0.0%(0/32)。58.8%(20/34)的大肠埃希菌标本来源于尿液,68.8%(22/32)的肺炎克雷伯菌标本来源于痰液。结论本院大肠埃希菌主要引起泌尿道感染,肺炎克雷伯菌主要引起呼吸道感染。临床可根据耐药监测常用的抗菌药物治疗肺炎克雷伯菌引起的感染,部分抗菌药物治疗大肠埃希菌引起的感染应根据药敏试验。

Objective To investigate the antibiotic resistance and distribution of Escherichia coli （E. coli） and Klebsiella pneumoniae （K. pneumoniar） in our hospital so as to provide a theoretical basis for clinical rational use of antibiotics. Methods Bacteria were identiifed by XK bacterial identiifcation instrument and bacterial susceptibility testing were detected with the XK-96A-C Drug sensitive plates. Results There were 34 strains of E. coli and 32 strains of K. pneumoniae were collected from October 2012 to August 2013. The resistance rates of 34 strains of E. coli to ampicillin, piperacillin, cefazolin, cotrimoxazole, cefuroxime, cefotaxime, aztreonam, cefepime, lomefloxacin, ciprofloxacin, ceftazidime, gentamicin, tobramycin, levofloxacin, nitrofurantoin, cefoxitin, amikacin, piperacillin/tazobactam, cefoperazone/sulbactam and imipenem were 70.6%（24/34）, 67.6%（23/34）, 64.7%（22/34）, 58.8%（20/34）, 55.9%（19/34）, 55.9%（19/34）, 52.9%（18/34）, 52.9%（18/34）, 52.9%（18/34）, 50.0%（17/34）, 44.1%（15/34）, 44.1% （15/34）, 38.2% （13/34）, 29.4% （10/34）, 14.7% （5/34）, 11.8% （4/34）, 11.8% （4/34）, 5.9% （2/34）, 2.9%（1/34） and 2.9%（1/34）, respectively. The resistance rates of 32 strains of K. pneumoniae to ampicillin, piperacillin, nitrofurantoin, cefazolin, cefuroxime, lomefloxacin, gentamicin, cefotaxime, cefepime, tobramycin, ciprofloxacin, aztreonam, ceftazidime, cotrimoxazole, amikacin, levofloxacin, cefoxitin, piperacillin/tazobactam, cefoperazone/sulbactam and imipenem were 100%（32/32）, 37.5%（12/32）, 31.3%（10/32）, 28.1%（9/32）, 28.1%（9/32）, 25.0%（8/32）, 21.9%（7/32）, 21.9%（7/32）, 18.8%（6/32）, 18.8%（6/32）, 18.8%（6/32）, 15.6%（5/32）, 15.6%（5/32）, 15.6%（5/32）, 12.5%（4/32）, 12.5%（4/32）, 9.4%（3/32）, 6.3%（2/32）, 6.3%（2/32） and 0.0%（0/32）, respectively. There were 58.8%（20/34） of E. coli were collected from urine specimens while 68.8% （22/32） of K. pneumoniae from sputum specimens. Conclusions In our hospital, urinary tract infections were mainly caused by E. coli, and respiratory infections were mainly caused by K. pneumoniae. The clinical could use common antibiotics to treat infections caused by K. pneumoniae in accordance with drug resistance surveillance, and some antimicrobial treatment of infections caused by E. coli should be based on susceptibility testing.