东莞地区某院2012～2014年肺炎克雷伯菌的临床分布及耐药性分析

Clinical of distribution of 410 strains of Klebsiella pneumoniae and its drug resistance analysis in a hospital of Dongguan during 2012-2014

目的调查东莞康华医院2012年至2014年从临床标本中分离的肺炎克雷伯菌的耐药趋势,为临床治疗提供可靠依据。方法收集送检标本中分离的肺炎克雷伯菌株,按照全国临床检验规程分离鉴定,并采用MIC法进行药敏试验,用纸片法进行ESBLs确认实验和改良Hodge试验检测产碳青霉烯酶表型确认,用WHONET5.4软件进行系统分析。结果共分离出410株肺炎克雷伯菌,以痰标本分离率最高,占55.87%。其次是脓液、分泌物、血液分别占9.53%、9.47%、8.78%;肺炎克雷伯菌主要来自ICU、呼吸内科、肿瘤内科,分别占16.10%、9.02%、7.80%;肺炎克雷伯菌对亚胺培南的耐药率为0.74%,对氨苄西林/舒巴坦、头孢唑啉、头孢吡肟、头孢噻肟、头孢曲松、头孢他啶、复方磺胺甲噁唑的耐药率逐年递减,对阿莫西林/克拉维酸的耐药率总体上呈上升趋势。结论对本地区肺炎克雷伯菌进行及时鉴定和药敏分析,跟踪其耐药趋势,可指导抗菌药物合理规范使用,降低抗菌药物的选择压力,以减少耐药株的产生。

Objective To investigate the drug resistance tendency of Klebsiella pneumoniae isolated from the clinical samples during 2012-2014 to provide reliable evidence for clinical treatment.Methods The Klebsiella pneumoniae strains isolated from the submitted specimens were collected and identified according to the national clinical test procedures,and the drug sensitivity test was performed by using MIC method.The confirmation test of ESBLs was conducted by using K-B method and the phenotype of carbapenemases producing was confirmed by using the improved Hodge test.Results Totally 410 strains of Klebsiella pneumoniae were isolated,55.87% of which were derived from sputum,and the rest was derived from pus（9.53%）,secretion（9.47%）and blood（8.78%）;Klebsiella pneumoniae was mainly originated from ICU,respiration department and oncology department,accounting for16.10%,9.02% and 7.80% respectively;the resistance rates of Klebsiella pneumoniae against imipenem was 0.74%,the resistance rates of Klebsiella pneumoniae against ampicillin/sulbactam,cafazolin,cefepime,cefotaxime,cefatriaxone,ceftazidine,compound sulfamethoxazole were decreased year by year,while which against amoxicillin/clavulanic acid showed the increasing trend as a whole.Conclusion Timely conducting the identification and drug susceptibility analysis on local Klebsiella pneumoniae and tracking its drug resistance trend can guide the rational and standardized use of antibacterial drugs,reduces the pressure for selecting antibacterial drugs in order to reduce the generation of drug resistant strains.