产超广谱β-内酰胺酶肺炎克雷伯菌耐药性分析

Analysis of Antibiotic Resistance of Klebsiella Pneumoniae Producing Extended-spectrum β-lactamases

目的探讨内蒙古兴安盟地区临床分离出的肺炎克雷伯菌的分布特点及耐药现状和发展趋势,为指导临床合理用药提供依据。方法以2015年1月1日至2017年12月31日临床分离的非重复的肺炎克雷伯菌806株为研究对象,应用VITEK-2微生物全自动分析仪对临床分离株进行菌种鉴定,同时采用K-B纸片扩散法或MIC法进行药物敏感性试验,采用美国临床和实验室标准委员会推荐的初筛试验和表型确证试验检测超广谱β-内酰胺酶,并按CLSI2016版标准判断细菌敏感或耐药。结果产ESBLs肺炎克雷伯菌主要以呼吸道感染为主。其检出率34.2%;产ESBLs肺炎克雷伯菌对临床常用抗菌药物耐药率大多显著高于其非产ESBLs菌株(P<0.001)。碳青霉烯类、阿米卡星、头孢西丁、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦等药物仍保持较高的抗菌活性。结论本地区产ESBLs肺炎克雷伯菌分离率较高,多重耐药现象严重。碳青霉烯类抗菌药物最敏感,应作为治疗产ESBLs菌株重度感染的首选药物,轻中度感染可根据药敏结果选择高敏感药物,哌拉西林/他唑巴坦和头孢哌酮/舒巴坦需加大剂量使用。应加强对耐药菌株的监测工作,对产ESBLs的细菌感染争取做到早期诊断、合理治疗、延缓耐药的发展、减少耐药菌株的产生、防止其扩散和爆发流行。

Objective To investigate the distribution of Klebsiella pneumoniae isolated in Xing-an Meng area of Inner Mongolia, and the current situation and development trend of drug resistance, so as to provide the basis for guiding the rational use of drugs in clinic. Method A total of 806 strains of Klebsiella pneumoniae, which were clinically isolated from January 1, 2015 to December 31, 2017, were studied. The clinical isolates were identified by VITEK-2 microbiological automatic analyzer. At the same time, K-B disk diffusion method or MIC method were used to test the drug sensitivity. The extended-spectrum beta lactamases （extended-spectrum beta-lactamases） were detected by the primary screening test and phenotypic confirmatory test recommended by the （clinical and laboratory standards Institute CLSI, and the susceptibility or drug resistance of the bacteria was determined according to the CLSI2016 standard. Results ESBLs producing Klebsiella pneumoniae was mainly caused by respiratory tract infection. The drug resistance rate of Klebsiella pneumoniae producing ESBLs was significantly higher than that of non-producing ESBLs strains （P〈0.O01）. Carbapenems, compound preparations of piperacillin/tazobactam, cefoperazone/sulbactam, amikacin, cefoxetine remained high antibacterial activity. Conclusions The isolation rate of Klebsiella pneumoniae is high and muhidrug resistance is serious in this area. Carbapenem is the most sensitive antimicrobial agent and should be the first choice for the treatment of severe infection of producing ESBLs strains. High sensitive drugs can be selected for mild to moderate infection according to the results of the drug sensitivity test, Piperacillin/tazobactam and cefoperazone/sulbactam require increased doses. It is necessary to strengthen the monitoring of drug-resistant strains, to make early diagnosis and reasonable treatment of ESBLs producing bacteria, to delay the development of drug resistance, to reduce the production of drug-resistant strains, and to prevent their spread and epidemic outbreak.