耐碳青霉烯类抗菌药物的肺炎克雷伯菌的耐药状况分析

Antimicrobial Resistance in Carbapenem-Resistant Klebsiella Pneumoniae

目的：了解南昌大学第三附属医院耐碳青霉烯类抗菌药物的肺炎克雷伯菌（CRKP）的耐药状况。方法将2009年1月至2013年12月临床送检合格标本，采用西门子Micro Scan Walk Away40 Plus 微生物分析仪及配套的革兰阴性菌鉴定药敏板，进行菌株鉴定与药敏试验，结果判读按照CLSI的标准，将分离到的肺炎克雷伯菌进行筛选，再筛选出CRKP。结果从检测到的769株肺炎克雷伯菌中筛选到17株CRKP。 CRKP发生率2009年为0.0%，2013年上升到4.3%。CRKP对加替沙星耐药率最低占33.3％，对氨苄青霉素、阿莫西林/棒酸、头孢唑啉、环丙沙星、替卡西林/棒酸、耐药率高达100.0％；头孢类除孢噻肟、头孢哌酮/舒巴坦耐药率在50.0%以下，其余的均在50.0%～100.0%。美洛配能亚胺培南耐药率高达80.0%以上。结论 CRKP对常用抗菌药物有严重的耐药趋势，对重症患者、感染严重患者，不能单凭经验用药，应依据药敏试验选择抗菌药物。

Objective To understand the antimicrobial resistance in carbapenem -resistant Klebsiella pneumoniae （CRKP） in the Third Affiliated Hospital of Nanchang University. Methods Strain identification and susceptibility testing were performed using Siemens Micro Scan Walk Away40 Plus microbial analyzer and gram -negative bacterial susceptibility plate in qualified specimens submitted Between January 2009 and December 2013. Results were interpreted in accordance with CLSI criteria and Klebsiella pneumoniae isolates were screened for CRKP. Results Seventeen CRKP stains were obtained from the 769 Klebsiella pneumoniae strains. The incidence of CRKP infections increased from 0.0%in 2009 to 4.3%in 2013. The gatifloxacin exhibited the lowest resistance to CRKP （33.3%）. However, ampicillin, amoxicillin/clavulanic acid, cefazolin, ciprofloxacin and ticarcillin/clavulanic acid had the highest resistance to CRKP （100.0%）.The resistance rates of CRKP to cephalosporins ranged from 50.0% to 100.0%（except cefotaxime and cefoperazone/sulbactam,〈50.0%）. In addition,resistance rates of CRKP to meropenem and imipenem were higher than 80.0%. Conclusion There is a trend of resistance to commonly used antimicrobial agents in CRKP. Antibacterial drugs can not be used empirically and should be chosen according to susceptibility test results in critically ill patients or patients with severe infection.