2007-2014年肿瘤患者分离肺炎克雷伯杆菌的分布特征及耐药性变迁

Distribution and drug resistance of Klebsiella pneumoniae detected in specimens of patients with cancer during 2007-2014

目的分析肿瘤医院患者中分离的肺炎克雷伯杆菌耐药性,为感染肺炎克雷伯杆菌的肿瘤患者的治疗提供依据。方法采用WHONET 5.6软件回顾性分析肿瘤专科医院2007-2014年间肺炎克雷伯杆菌的检出率及耐药性。并按标本来源作进一步的耐药分析。结果在2007-2014年的标本中肺炎克雷伯杆菌共分离出3 665株,其中痰液标本中分离出2 230株。痰液标本和非痰液标本的科室分布都以放疗病房最多。肺炎克雷伯杆菌对奈替米星、替加环素最敏感,对氨苄西林耐药率极高,八年中,头孢菌素类抗生素和复方新诺明在2009年耐药性达到最高,后逐渐下降,喹诺酮类及碳青霉烯类药物耐药率有一定波动,但总体较好。痰液标本和非痰液标本的肺炎克雷伯杆菌的耐药性之间的差异具有统计学意义。结论肿瘤患者肺炎克雷伯杆菌引起的感染耐药性较综合性医院低;放、化疗患者由于多种原因呼吸道更易被肺炎克雷伯杆菌感染;及时监控和掌握肿瘤患者痰液中肺炎克雷伯的耐药特点,合理使用抗菌药物,是控制和减少多耐药性肺炎克雷伯杆菌感染的关键。

Objective To provide important basis for clinical treatment with antimicrobial agents in cancer patients with Klebsiella pneumoniae infection.Methods The detection rate and drug resistance of Klebsiella pneumoniae isolates in our hospital during 2007-2014 were analyzed retrospectively by WHONET 5.6software.Results 3665 strains of Klebsiella pneumoniae were isolated,2 230 strains of which were from sputum specimens;The specimens from radiotherapy wards ranked the frist.The Klebsiella pneumoniae strains were highly susceptible to Netilmicin and Tigecycline,while highly resistant to ampicillin.The resistance rates to cephalosporins and trimesulf reached the peak value in 2009;the resistance rates to quinolones and carbapenems didn＇t change much.The difference of drug resistance between Klebsiella pneumoniae from sputum specimens and those from other specimens was significant.Conclusion The drug resistance of Klebsiella pneumoniae isolated from sputum specimens of patients with cancer is lower than that of patients without cancer.Due to many reasons,patients accepted radiotherapy or chemotherapy are susceptive to Klebsiella pneumoniae infection.Monitoring of the durg resistance of Klebsiella pneumoniae from sputum specimens and rational use of antibiotics are the key to the control and reduction of infection caused by multidurg resistant Klebsiella pneumoniae.