临床分离肺炎克雷伯菌的分布及药敏试验结果分析

DISTRIBUTION AND DRUG RESISTANCEOFCLINICALLY ISOLATEDKLEBSIELLA PNEUMONIA IN OUR HOSPITAL

目的分析近三年来本院住院部分离出的肺炎克雷伯菌对本院常见抗菌药物的敏感性,为临床治疗方案提供借鉴,并验证本科室自行创建的细菌耐药预警检测系统。方法以本院近三年来住院患者肺炎克雷伯菌阳性的样本167株为研究对象,采用法国ATB Expression微生物鉴定系统对肺炎克雷伯菌进行鉴定并对20种抗菌药物进行药敏试验。所有数据均在Excel软件进行统计学处理分析。结果 167株肺炎克雷伯菌感染最严重的是烧伤科（60株,占35.92%）,感染率最高的标本类型是痰液及下呼吸道分泌物（113株,占67.66%）,肺炎克雷伯菌对亚胺培南、美洛培南和哌拉西林/他唑巴坦的敏感率分别为95.21%、94.01%和85.63%;阿莫西林、替卡西林、哌拉西林三种抗菌药物敏感率为0%;阿米卡星、奈替米星、头孢西丁这三种抗菌药物敏感率在60%-80%之间;其余9种抗菌药物均在30%-70%之间;在不同性别患者来源菌株中,仅有美洛培南具有统计学意义（U=2.2,p〈0.05）,在不同标本来源菌株中,哌拉西林/他唑巴坦具有统计学意义（U=2.27,p〈0.05）。结论肺炎克雷伯菌的耐药性已十分严重,但某些抗菌药物在不同性别、不同标本来源中具有显著差异,实验室应加强感染菌株的监测,建立更加完善的细菌耐药预警监测系统及制度,临床应根据药敏试验结果合理使用抗生素,避免无效治疗及菌株耐药。

Objective To analyze the sensitivity of Klebsiella pneumonia isolated from our hospital in recent three years to common antimicrobial agents,so as to provide theory for making a rational therapy plan and to validate the bacteria resistant early warning and monitoring system self- created by our department. Methods 167 positive strains of Klebsiella pneumonia collected from patients in our hospital over the past three years were identified with ATB Expression microbial identification system. Drug sensitivity test of 20 kinds of antimicrobial agents was performed. All data were statistically analyzed in the Excel. Results In 167 strains of Klebsiella pneumonia,Burns Department was the most serious（ 60 strains,accounting for 35. 92%）. The specimen types with the highest infection rates were sputum and lower respiratory tract（ 113 strains,accounting for 67. 66%）. Drug sensitivity rates to imipenem,meropenem and piperacillin / tazobactam were 95. 21%,94. 01% and 85. 63%. Drug sensitivity rates to Amoxicillin,ticarcillin and piperacillin all were0%. Drug sensitivity rates to amikacin,netilmicin and cefoxitin were between 60% and 80%. Drug sensitivity rates to the rest 9 kinds of bacterial drugs were between 30% and 70%. In strains from patients of different sex,only meropenem had a statistical significance（ U = 2. 2,p〈0. 05）. In strains from different specimens,piperacillin / tazobactam had a statistical significance（ U = 2. 27,p〈0. 05）. Conclusion Drug resistance of Klebsiella pneumonia has been very serious,but some antimicrobial agents have significant differences in strains from patients of different sex and different specimens. Thus,the laboratories should strengthen the monitoring of infected strains and establish the more perfect bacteria resistant early warning and monitoring system and rules. Rational use of antibiotics in clinic should be based on drug test results to avoid the futile treatment and drug resistance of strains.