2011年-2013年肺炎克雷伯菌医院感染及耐药性分析

Analysisi of Klebsiella pneumoniae nosocomial infections and drug resistance from 2011 to 2013

目的了解医院肺炎克雷伯菌感染分布情况和耐药性,为临床医师合理选择抗菌药物提供科学依据。方法搜集2011年-2013年临床送检的各类感染性标本进行培养、分离,检出2 119株肺炎克雷伯菌,采用VITEK-2 Compact型全自动细菌鉴定分析系统,用GN卡对其进行鉴定,药敏采用AST-GN药敏卡进行药敏分析。ESBLs菌株鉴定用复合纸片确证试验,对碳青霉烯酶类药物耐药菌株,采用改良Hodge试验进行确证,并进行耐药性分析。结果 2 119株肺炎克雷伯菌中痰液、尿液、血液标本占94.0%,其中痰液占79.5%;感染菌株主要分布于ICU、呼吸内科、综合内科病区;其逐年检出率有所增高,分别为:9.0%、9.7%、11.4%,产超广谱β-内酰胺酶(ESBLs)的530株占25.01%,对多种抗菌药物耐药率为:氨苄西林100%耐药,头孢替坦、哌拉西林/三唑巴坦、阿米卡星的耐药率较低,分别为5.92%、3.73%、2.64%,厄他培南、亚胺培南的耐药率分别为2.37%、1.91%。结论该院肺炎克雷伯菌临床分离株有逐年升高的趋势,产ESBLs菌株多重耐药现象突出,临床应重视其流行情况并合理使用抗菌药物。

Objective To investigate the distribution and the drug resistance of Klebsiella pneumoniae in our hospital,and provide reference for the rational use of antimicrobial agents in clinic. Methods Collected all kinds of infectious specimens from clinical from 2011 to 2013,and all of them were cultured,separated,and 2 119 strains of K. pneumoniae were isolated finally.Then,with the VITEK- 2 Compact,identify the samples by GN card. Drug sensitivity was analyzed with AST- GN drug sensitive card. Extended spectrum β- lactamases（ ESBLs） were determined by phenotypic confirmatory test. Carbopenems drug-resistant strains were confirmed by the modified Hodge test,and the drug- resistance was analyzed. Results 94. 0% of total2 119 strains of K. pneumoniae were isolated from urine,sputum,blood,and 79. 5% of them were isolated from sputum. The infections caused by K. pneumoniae were frequently occurred in patients in intensive care units（ ICU）,department of respiratory,and department of internal medicine. The detection rate increased in three years,respectively 9. 0% in 2011,9. 7% in2012 and 11. 4% in 2013. The isolated ratio of ESBLs producing K. pneumoniae was 25. 01%. The rates of resistance to ampicillin was 100%,and the resistance rate to tobramycin,piperacillin / tazobactam,amikacin,imipenem and ertapenem was low only 5. 92%,3. 73%,2. 64%,1. 91% and 2. 37% respectively. Conclusion Antimicrobial resistance and the isolation rates of ESBLs producing K. pneumoniae in our hospital increased year by year,and the situation of multidrug resistance of ESBLs producing strains was very prominent. It should be paid attention to the epidemic status of strains and rational use of antimicrobials agents in clinic.