基层医院产超广谱β-内酰胺酶肺炎克雷伯杆菌医院感染及耐药性变迁

Hospital infection and resistance change of extended spectum β-lactamases producing Klebsiella pneumoniae in primary hospitals

目的了解产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯杆菌在基层医院临床标本中的分布及其耐药趋势。方法用全自动微生物分析系统进行菌种鉴定及药物敏感性检测,采用K-B纸片扩散法检测ESBLs,采用改良Hodge试验检测菌株产碳青霉烯酶,并按年度统计其感染率及耐药性。结果 2011年至2014年肺炎克雷伯杆菌产ESBLs的检出率分别为17.05%、17.76%、27.05%和30.93%,平均为25.04%。标本来源主要为痰,占67.84%;科室分布以ICU、神经内科、呼吸内科为主,分别为34.50%、20.47%和12.28%。对常用抗生素的耐药性总体呈升高趋势,2013年和2014年共检出10株对碳青霉烯类药物耐药菌株。结论医院产ESBLs肺炎克雷伯杆菌数量及检出率逐年升高,多重耐药日趋严重,临床应加强细菌耐药监测,科学合理应用抗菌药物,延缓细菌耐药性的变迁,预防和控制医院感染扩散。

Objective To explore the clinical distribution and resistance trend of extended spectrumβ-lactamases（ESBLs）producing Klebsiella pneumoniae in primary hospitals.Methods The bacteria identification and drug sensitivity test were done by automatic microbial analysis system.K-B disc diffusion method was used to screen ESBLs and modified hodge method to screen carbapenemase-producing strains.The infection rate and the drug resistance rate were analyzed on a yearly basis.Results The detection rates of ESBLs-producing Klebsiella pneumoniae from 2011 to 2014were 17.05%,17.76%,27.05% and 30.93%respectively,about 25.04% on average.Sputum specimens were the main sources,accounting for 67.84%.ICU,neurology and respiratory medicine departments were the main sources of the specimens,accounting for34.50%,20.47% and 12.28%respectively.The resistances to commonly used antiotics showed an increasing trend.10carbapenem-resistant strains were detected in 2013 and 2014.Conclusion The number and detection rate of ESBLs-producing Klebsiella pneumoniae increased year by year,and the multi-drug resistance has become increasingly serious.Clinical monitoring of bacterial drug resistance should be strengthened,and antibacterial drugs should be scientifically and rationally used to put off the change of drug resistance and to prevent and control the spread of hospital infections.