白族地区肺炎克雷伯菌临床分布及耐药分析

Drug resistance and clinical distribution of Klebsiella pneumoniae from May 2016 to May 2017 in the area of the Bai nationality

目的调查白族地区住院患者标本中分离到的肺炎克雷伯菌的临床分布及耐药分布,为临床治疗提供依据。方法对大理市第一人民医院2016年5月至2017年5月住院患者送检标本进行细菌分离,对得到的肺炎克雷伯菌进行临床分布、耐药率分布及耐药谱分析。结果送检的1 342份各类样本中,共分离到肺炎克雷伯菌菌株262株,检出率19.52%(262/1 342)。菌株主要来自新生儿科、重症加强治疗病房、呼吸内科、儿科,标本主要来自痰液(78.24%,205/262)。22种抗菌药物中,所有菌株对氨苄西林均耐药,对厄他培南均敏感,产超广谱β-内酰胺酶(ESBLs)菌株(106株)耐药率高于不产ESBLs菌株(156株)(χ~2=261.992,P<0.01)。共有76种耐药图谱,大部分图谱为多重耐药,有一种图谱(共计116株,占44.27%)只对氨苄西林抗生素耐药,其他耐药谱中菌株数从1～16株不等。262株菌株中,只有1株耐阿米卡星,有2株菌为亚胺培南与美罗培南耐药菌株。结论白族地区人群中的肺炎克雷伯菌中,存在多种多重耐药菌,尚未发现广泛耐药和泛耐药菌株;发现耐碳青霉烯类抗生素的菌株,应值得临床持续关注。

Objective To retrospectively analyze antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains for guiding the rational use of antibiotics in the area of the Bai nationality.Methods The antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains were retrospective analyzed,which were isolated from specimens of inpatients in First People’s Hospital of Dali between May 2016 and May 2017.Results Among the1 342 samples of various kinds of samples,262 strains of Klebsiella pneumoniae were isolated,with the detection rate of19.52%(262/1342).Clinical isolated strains were mainly from the new pediatric,intensive care unit,respiratory medicine,pediatrics,and mostly from sputum specimens(78.24%,205/262).By screening of 22 kinds of antimicrobial agents,all strains had ampicillin resistance(100.00%),while none of these strains had ertapenem resistance.Extendedspectrum β-lactamases(ESBLs) positive strains’ resistance rate was higher than ESBLs negative strains(χ^2=261.992,P<0.01).There were 76 drug resistant profiles,most of which were multidrug-resistant bacteria except 116(44.27%)strains were resistant to ampicillin antibiotics only.And the number of strains in other resistant types ranged from 1 to 16.Only one of 262 strains had amikacin resistance,two of them were resistant to imipenem and meroenan.Conclusions There are many multidrug-resistant bacteria in Klebsiella pneumoniae in the population of Bai nationality,and there are no extensively drug resistant bacteria and pandrug-resistant bacteria strains.The strains of carbapene-resistant antibiotics should be worthy of clinical attention.