关于肺炎克雷伯菌产碳青霉烯酶特性及耐药趋势分析

Analysis of Characteristics of Klebsiella Pneumoniae Producing Carbapenemases and Trend of Drug Resistance

目的:分析肺炎克雷伯菌产碳青霉烯酶特性与耐药趋势。方法:选取2016年1月~2016年4月期间,某院分离的耐碳青霉烯类肺炎克雷伯菌183株,分别采用VITEK-2Compact全自动细菌分析仪与K-B纸片法,对菌株对于药物的敏感性进行检测,通过改良Hodge试验,检测其是否产生碳青霉烯酶,采用EDTA抑制试验方法,检测其是否产出金属酶。结果:临床分离出的肺炎克雷伯菌中CRKP的比例为2015年0.2%,2016年3.7%,耐药性呈显著上升趋势(P<0.05),且药敏结果显示,肺炎克雷伯菌除了对碳青霉烯类药物有较高的耐药性之外,对氨曲南、头孢曲松以及环丙沙星等抗菌类药物均有多重耐药性;改良Hodge试验结果显示,183株耐碳青霉烯类肺炎克雷伯菌中有180株呈阳性。结论:2015年~2016年间,分离的CRKP比例呈逐年上升趋势,且对多种抗菌药物均有耐药性,而产出的KPC-2型碳青霉烯酶,是导致分离菌株对碳青霉烯类抗菌药物耐药性的主要原因。

Objective：To analyze the characteristics of klebsiella pneumoniae producing carbapenemases and trend of drug resistance.Methods：183isolated carbapenem-resistant klebsiella pneumoniae in a hospital from January 2016 to April 2016 were selected.The sensitivity of bacterial strain to the drug were respectively detected by VITEK-2Compact automatic bacterial analyzer and K-B method,then using the modified Hodge test detected whether it produced carbapenemases,and using EDTA inhibition test method detected whether the Metalloenzymes were output.Results：The proportion of CRKP in clinical isolated klebsiellapneumoniae was 0.2%in 2015 and 3.7%in 2016,the drug resistance was obviously increased（P0.05）.The drug sensitivity results showed that klebsiella pneumoniae not only had higher drug resistance for carbapenems,but also had multi-drug resistance for anti-infective drugs such as aztreonam,ceftriaxone,and ciprofloxacin.The modified Hodge test results showed that there 180 cases in 183 cases of carbapenem-resistant klebsiella pneumoniae were positive.Conclusion：In 2015-2016,the proportion of isolated CRKP is increased year by year,it has drug resistance for multiple antimicrobial drugs,and the output type KPC-2carbapenemases is the main reason of antimicrobial resistance of isolated strain for carbapenems.