91株肺炎克雷伯菌的耐药性分析

An analysis of antibiotic resistance of 91 isolates of Klebsiella pneumonia

目的分析肺炎克雷伯菌(KPN)的耐药性特征。方法采用Vitek-2Compact全自动微生物系统鉴定菌种及药敏分析仪对临床分离菌进行鉴定和药敏分析,同时检测超广谱β内酰胺酶(ESBLs),分析不同药物在KPN整体耐药性中的影响。结果 91株KPN血流感染,感染途径依次为呼吸道感染32例(35.2%),深静脉置管11例(12.1%),肝脓肿10例(11.0%)。KPN对氨苄西林、头孢噻肟和复方新诺明的耐药率依次为87.9%、45.1%和42.8%。对KPN不同药物的耐药性进行赋值评分与Cox危险回归分析显示,庆大霉素、氨苄西林、头孢唑林、亚胺培南、复方新诺明、头孢他啶及哌拉西林/他唑巴坦对KPN的整体耐药性影响最为显著(P<0.01);累积生存函数曲线分析显示,耐药危险性随着耐药积分增加而增加。结论鉴于KPN耐药性不断增加的复杂性,在临床经验用药前应当对其耐药性进行精准评估,根据实际情况合理选择抗菌药,从而减少耐药菌株的出现,提高感染的临床治愈率,改善患者预后。

Objective To investigate the characteristics of antibiotic resistance of K lebsiella pneumonia .Methods With Vitek‐2 Compact automatic bacteria identification system ,all strains of K lebsiella pneumonia were identified and the susceptibility to antibiotics was analyzed .The extend‐spectrum β‐lactamase（ESBLs） was detected by a double disk synergy test .The effects of different drugs on the general resistance of K lebsiella pneumonia were analyzed .Results The K lebsiella pneumonia‐positive specimens were mostly derived from respiratory tract infection in 32 cases （35.2% ） ,deep venipuncture in 11 cases（12.1% ） ,and liver abscess in 10 cases（11.0% ） .The rates of drug resistance to different antibiotic agents were 87.9% for ampicillin ,45.1% for cefotaxime , and 42.8% for sulfamethoxazole .By assigning risk score to different drug resistance of K lebsiella pneumonia ,Cox regression analysis showed that the influence of gentamycin ,ampicillin ,cefazolin , imipenem ,sulfamethoxazole ,ceftazidime and piperacillin/tazobactam on the drug resistance of K lebsiella pneumonia was the most significant （ P〈0 .05 ） .The survival function curve analysis showed that resistance risk was increased as the drug‐resistant cumulative increased .Conclusion Because of the increasing complexity of the K lebsiella pneumonia resistance ,more attention should be paid to the clinical practices as to the precise assessment of drug resistance ,and the selection of antibiotic drugs should be made according to actual needs ,so as to reduce the emergence of resistant strains ,improve clinical cure rate of infection and the prognosis of patients .