肺炎克雷伯菌的分布及耐药性分析

Distribution and antimicrobial resistance profile of Klebsiella pneumoniae

目的调查广西医科大学第一附属医院临床分离肺炎克雷伯菌的科室分布与耐药特点,为肺炎克雷伯菌感染治疗提供抗菌药物选择理论依据。方法收集2015年1-12月住院患者分离的非重复肺炎克雷伯菌,采用VITEK 2-Compact60自动分析仪与纸片扩散法进行菌种鉴定及药敏分析,对其标本类型、科室分布及常用22种抗菌药物药敏结果进行统计分析。结果获取非重复分离的肺炎克雷伯菌753株,痰液标本检出最多,308株,占40.9%;其次尿液137株,占18.2%;分离自年龄>60岁患者菌株307株,占40.8%;检出率高的科室前2位的是ICU和呼吸内科,分别为126株(16.7%)和103株(13.7%);同期以呼吸系统感染收治入院者144例,分离得肺炎克雷伯菌103株,该菌感染率71.5%。肺炎克雷伯菌株对哌拉西林、头孢唑林和头孢呋辛耐药率分别为66.3%、60.8%和59.4%,对亚胺培南与美罗培南耐药率分别为2.4%与2.0%;产ESBL肺炎克雷伯菌410株(54.4%),耐碳青霉烯类菌株29株(3.9%);多重耐药(MDR)菌株492株(65.3%)。结论该院肺炎克雷伯菌耐药严重,其主要分离自痰液、尿液标本,ESBL阳性菌株与MDR菌株检出率均较高,医院需加强对肺炎克雷伯菌感染者的目标性监测,控制MDR肺炎克雷伯菌在医院内的流行。

Objective To investigate the clinical feature and antibiotic resistance profile of K. pneumoniae isolates from patients for better management of K. pneumoniae infections. Methods Nonduplicate K. pneumoniae strains were collected from January to December in 2015. K. pneumoniae strains were identified by VITEK 2-Compact 60 and tested for antimicrobial susceptibility by Kirby- Bauer method. Results A total of 753 strains of K. pneumoniae were included, most （40.9 %, 308/753） of which were isolated from sputum, followed by urine （18.2%, 137/753）. Most of the strains were from old patients at least 60 years of age （40.8%, 307/753）, and primarily from intensive care units （16.7 %, 126/753） and Department of Respiratory Medicine （13.7%, 103/753）. Respiratory tract infection was found in 144 patients, of which 71.5% （103/144） were due to K. pneumoniae. More than half of the K. pneumoniae strains were resistant to piperacillin （66.3 %）, cefazolin （60,8 %） and cefuroxime （59.4 %）. Only a few strain were resistant to imipenem （2.4 %） and meropenem （2.0）. ESBLs were produced in 410 （54.4%） of the 753 strains, and 29 （3.9 %） strains were carbapenem-resistant, 492 （65.3 %） strains were resistant to multiple antimicrobial agents. Conclusions Clinical K. pneumoniae isolates are highly resistant to most of the antimicrobial agents tested. The strains were mostly isolated from sputum and urine, and positive for ESBLs. MDR K. pneumoniae strains are emerging. K. pneumoniae isolates are still very susceptible to carbapenems in vitro.