我院患者肺炎克雷伯菌的临床分布及耐药性分析

Distribution and antibiotic resistance of Klebsiella pneumoniae in our hospital

目的分析我院住院患者肺炎克雷伯菌的临床分布及耐药性,以指导临床合理用药。方法对2012~2014年的临床标本按照常规进行病原菌分离,采用VITEK2全自动细菌鉴定与药敏分析仪对肺炎克雷伯菌进行鉴定。结果共分离出肺炎克雷伯菌1 099株,其中产超广谱β-内酰胺酶（ESBLs）菌株428株,占38.94%。在多药耐药患者中,男性明显多于女性,且主要分布于高龄和低龄患者中,60岁以上的患者占71.34%。检出肺炎克雷伯菌主要来源于痰液（67.87%）,其次是尿液（11.01%）;肺炎克雷伯菌感染主要分布于重症医学科（32.12%）,其次为呼吸内科（18.29%）;肺炎克雷伯菌对美罗培南、亚胺培南、头孢替坦、哌拉西林/他唑巴坦和厄他培南的耐药率较低（≤5%）,对氨苄西林、哌拉西林、头孢唑啉耐药率较高（≥50%）。结论我院住院患者肺炎克雷伯菌临床分布主要集中在重症医学科,可选用的抗生素是碳青霉烯类、复合酶抑制剂、阿米卡星;选择哌拉西林和第三、四代头孢菌素时应慎重。

Objective To analyze the hospitalized patients clinical distribution and drug resistance of K lebsiella pneumoniae during 2012 to 2014 ,and to guide rational clinical application .Methods From 2012 to 2014 ,clinical specimens of pathogen were separated and identified ,according to conventional VITEK2 automatic bacteria identification and drug susceptibility analyzer .Results A total of 1 099 strains K lebsiella pneumoniae was isolated ,in which the ultra broad spectrum beta lactamase ESBLs strains were 428 ,ac‐counting for 38 .94% .In patients with multi‐drug resistance ,more men than women ,apparently and mainly distributed in older and younger patients ,age of 60 or older patients （71 .34% ） .K lebsiella pneumoniae mainly come from sputum （67 .87% ） ,followed by urine （ 11 .01% ）;K lebsiella pneumoniae infection was mainly distributed in the intensive care department （32 .12% ） ,followed by the respiratory department （18 .29% ） .Conclusion K lebsiella pneumoniae infection in hospitalized patients mainly distributed in the intensive care department .Penicillium alkene ,compound enzyme inhibitors ,amikacin are selected .Piperacillin should be select‐ed w ith care .