肿瘤患者合并肺炎克雷伯菌肺部感染的耐药性监测

Drug resistance surveillance of tumor patients with Klebsiella pneumoniae lung infection

目的分析本院肺炎克雷伯菌致肿瘤患者肺部感染连续10年耐药性变迁和产超广谱β-内酰胺酶情况,为临床预防和控制感染提供依据。方法对2005年-2014年本院细菌耐药监测资料中肺炎克雷伯菌的耐药性进行回顾性分析。结果肺炎克雷伯菌致肿瘤患者肺部感染临床标本主要来源于痰液（61.9%）,药敏试验表明,10年间肺炎克雷伯菌对常用抗菌药物的耐药率呈普遍增长趋势,产ESBLs菌和非产ESBLs菌对β-内酰胺酶类和非β-内酰胺酶类抗菌药物的耐药率均显著增高,对氨苄西林天然耐药,对第1代~第4代头孢菌素的耐药率为11.4%~52.6%,对阿米卡星、头孢西丁、妥布霉素、替加环素、碳青霉烯类、含β-内酰胺酶抑制剂复合制剂敏感,耐药率〈20.0%,该菌ESBLs发生率较高（21.1%~46.6%）。结论从肿瘤患者下呼吸道标本中分离出的肺炎克雷伯菌,对常用抗菌药物的耐药性10年间呈普遍增长趋势,对各类抗菌药物呈现不同程度的耐药,ESBLs检出率总体呈上升趋势,临床医生应引起重视,加强对其耐药性监测和控制工作。

Objective To analyze the drug resistance change of Klebsiella pneumoniae bacteria causing tumor patients＇ lung infection in continuous 10 years and the ultra broad spectrum beta lactamase situation,so as to provide basis for the clinical prevention and control of infection. Methods From 2005 to 2014 in our hospital,the drug resistance of Klebsiella pneumoniae of bacterial drug resistance monitoring data were retrospectively analyzed. Results Klebsiella pneumoniae causing lung infection in patients with clinical tumor mainly came from sputum specimens（ 61. 9%）,and drug sensitive test showed that,during the 10 years,Klebsiella pneumoniae resistance to commonly used antimicrobial agents showed a growing trend; the resistance rate of ESBLs- producing bacteria and non- ESBLs producing bacteria to β- lactamases and non- β- lactam antimicrobials significantly increased,which was natural resistant to ampicillin,and the resistance rate to cephalosporins from the first generation to the fourth generation was among 11. 4%- 52. 6%,and sensitive to amikacin,cefoxitin,tobramycin,tigecycline,carbapenems,containing beta lactamase inhibitor,with drug resistance rate less than 20%,it was a high incidence rate of ESBLs（ 21. 1%- 46. 2%）. Conclusion The antimicrobial resistance of Klebsiella pneumonia isolated from lower respiratory tract specimens of cancer patients to normal antibiotics in the 10 years showed a growing trend,and different degree of drug resistance to all kinds of antibacterial drugs. The detection rate of ESBLs in general was on the rise,which should attract clinicians＇ attention,so as to strengthen the resistance monitoring and control work.