2011-2013年肺炎克雷伯菌的分布与耐药性变迁

Clinical distribution and change of drug resistance of Klebsiella pneumoniae during 2011-2013

目的：了解2011－2013年胸科医院肺炎克雷伯菌的临床分布及对常用抗菌药物的耐药性变迁趋势，为临床合理选用抗菌药物提供理论依据。方法回顾性分析2011－2013年临床分离的肺炎克雷伯菌药敏结果，细菌培养严格按照《全国临床检验操作规程》，细菌鉴定采用法国生物梅里埃公司的A PI板条和软件系统，药敏试验采用K‐B法，依据CLSI最新版本进行结果评价。结果2011－2013年在各类感染性标本中共分离出791株肺炎克雷伯菌，3年分离率依次为16．4％、15．7％和18．0％，送检标本以痰液最多占84．0％；3年产 ESBLs肺炎克雷伯菌检出率依次为33．9％、32．8％和39．3％；产ESBLs肺炎克雷伯菌对亚胺培南、美罗培南、头孢西丁、哌拉西林／他唑巴坦、阿米卡星、头孢呱酮／舒巴坦和头孢吡肟耐药率均＜19．7％，对其他常用抗菌药物的耐药率在20．0％～100．0％；非产ESBLs肺炎克雷伯菌对抗菌药物的耐药率明显低于产ESBLs肺炎克雷伯菌，差异有统计学意义（P＜0．05）。结论临床对阿莫西林／克拉维酸、氨苄西林／舒巴坦和氨曲南等耐药率有增加趋势的抗菌药物，应合理使用，特别是哌拉西林／他唑巴坦、头孢呱酮／舒巴坦和头孢吡肟3种抗菌药物的耐药率有增加趋势应引起临床的重视。

OBJECTIVE To learn the clinical distribution and trends of antimicrobial resistance to common antibiotics of K lebsiella pneumoniae isolated from 2011 to 2013 in the chest hospital so as to provide the basis for reasonable application of antibiotics .METHODS The drug sensitive results of all the clinical isolates of K .pneu‐moniae were analyzed retrospectively from 2011 to 2013 .Bacterial culture was performed strictly according to National Guide to Clinical Laboratory Procedures .The API kits and relative software （France ,Merieux ） were used to identify the bacteria .The drug susceptibility tests were performed by K‐B method .The testing results were assessed according to the latest version of CLSI breakpoints .RESULTS Totally 791 strains of K .pneumoni‐ae were isolated from all kinds of infected samples from 2011 to 2013 .The isolation rates in the three years were 16 .4% ,15 .7% and 18 .0% ,respectively ,and the sputum samples accounted for the majority of 84 .0% .The detection rate of the ESBLs‐producing K .pneumoniae were 33 .9% ,32 .8% and 39 .3% ,respectively .The drug resistance of the K .pneumoniae of the ESBLs‐producing strains were lower to imipenem ,metropenem ,cefoxitin , piperacillin/tazobactam ,amikacin ,cefperazone/sulbactam and cefepime ,and the drug resistance rates were less than 19 .7% .The drug resistance rates to other common used antibiotics were between 20 .0% and 100 .0% .The drug resistance rates to antibiotics of non‐ESBLs‐roducing strains were significantly lower than those ESBLs‐producing strains （P〈 0 .05） .CONCLUSION The drug resistance rates to amoxicillin/clavulanate ,ampicillin/sulbactam ,and aztreonam show upward trends .Special attention should be paid to the three drugs of piperacillin/tazobactam ,cefoperazone/sulbactum and cefepime .