NICU患者感染肺炎克雷伯菌与耐药性研究

Klebsiella pneumoniae infections in patients of NICU and analysis of drug resistance

目的分析神经重症监护病房(NICU)患者肺炎克雷伯菌(KPN)感染及耐药性,为临床预防和治疗提供理论依据。方法 2013年1月1日-2014年12月31日对医院NICU各类感染患者送检标本进行菌种鉴定,对分离出的KPN进行药物敏感性试验,对产ESBLs菌种进行确证试验,使用SPSS17.0软件对数据进行统计分析。结果 2013、2014年检出KPN分别为44、31株,其中产ESBLsKPN分别为11、7株,分别占25.00%、22.58%,两者比较差异无统计学意义;两年中KPN对氨苄西林及哌拉西林几乎完全耐药,对哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星、头孢替坦、庆大霉素、阿米卡星等抗菌药物表现为很高敏感性,敏感率均在80.00%以上;2013年对美罗培南及亚胺培南完全敏感,2014年出现耐药菌株,耐药率为9.68%;产ESBLs菌株对多数抗菌药物均有很高耐药性。结论 KPN是NICU患者感染的重要病原菌,产ESBLs菌株耐药性明显高于非产ESBLs菌株,因此产ESBLs是KPN产生耐药性的重要机制。

OBJECTIVE To analyze the prevalence of K lebsiella pneumoniae infections in the patients of neurologi‐cal intensive care unit （NICU ） and observe the drug resistance so as to provide theoretical bases for clinical preven‐tion and treatment .METHODS The submitted specimens were collected from the patients with various types of in‐fections who were treated in the NICUs from Jan 1 ,2013 to Dec 31 ,2014 ,then the bacterial identification was carried out ,the drug susceptibility testing was performed for the isolated K .pneumoniae strains ,the confirmatory test was conducted for the ESBLs‐producing strains ,and the data were statistically analyzed by using SPSS17 .0 software .RESULTS Totally 44 strains of K .pneumoniae were isolated in 2013 ,31 strains in 2014 ;the ESBLs‐pro‐ducing K .pneumoniae accounted for 25 .00% （11 strains） in 2013 ,22 .58% （7 strains） in 2014 ,and there was no significant difference .Almost all of the isolated K .pneumoniae strains were resistant to ampicillin and piperacillin in the two years but were highly susceptible to piperacillin‐tazobactam ,ciprofloxacin ,levofloxacin ,cefotetan , gentamicin ,and amikacin ,with the drug susceptibility rate more than 80 .00% .The strains were completely sus‐ceptible to meropenem and imipenem ,but the drug‐resistant strains have emerged in 2014 ,with the drug resist‐ance rate of 9 .68% .The ESBLs‐producing strains were highly resistant to most of the antibiotics .CONCLUSION The K .pneumoniae is dominant among the pathogens causing infections in the NICU patients .The drug resistance rate of the ESBLs‐producing strains is significantly higher than that of the non‐ESBLs‐producing strains ,thus ,the production of ESBLs is an important mechanism inducing the drug resistance of the K .pneumoniae .