碳青霉烯类抗生素耐药肺炎克雷伯菌的分布及耐药性分析

Distribution and drug resistance analysis of carbapenems-resistant KlebsieHa pneumoniac

目的调查碳青霉烯类抗生素耐药肺炎克雷伯菌（CRKP）的临床分布及其耐药特性，为临床防治提供依据。方法收集2014年1月至2016年12月绍兴市人民医院住院患者的各类送检标本中分离的134株CRKP，进行细菌鉴定及配套革兰阴性细菌药敏卡药敏试验，加测其他临床常用抗菌药物的敏感性，并对CRKP的临床分布特点及对抗菌药物的耐药情况进行调查分析。结果134株CRKP主要来自尿液（70例，52．2％）和痰液（38例，28．4％）。CRKP患者的科室主要来自神经外科（包括神经外科重症监护病房）、ICU、肝胆外科和泌尿外科，分别占47．8％（641134）、23．9％（32／134）、8．2％（11／134）和6．0％（8／134）。在22种抗菌药物中，CRKP对16种抗菌药物的耐药率〉90％，其中氨苄西林的耐药率为100％，对19种抗菌药物的耐药率〉80％，仅对替加环素的耐药率〈50％，为23．1％。超广谱B-内酰胺酶（ESBLs）阳性菌株16株，占11．9％。除1株对2类抗菌药物耐药外，其余均对3类以上抗菌药物耐药。结论CRKP临床分布广泛，耐药情况严重，临床可选用的抗菌药物有限，替加环素对CRKP仍具有较强的抗菌活性。

Objective To investigate the clinical distribution and drug resistance of carbapenems- resistant Klebsiella pneurnoniae （CRKP）. Methods A total of 134 clinical strains of CRKP were collected from inpatients in our hospital from January 2014 to December 2016. VITEK-2 compact automatic microbiological analyzer was used to identify the bacteria and the supporting gram-negative bacterial drug susceptibility card was used for susceptibility testing. The sensitivity of other clinical commonly used antimierobial agents was measured by K-B method. And the clinical distribution of CRKP and its resistance to antimierobial agents were investigated and analyzed. Results The clinical strains of CRKP were isolated mainly from urine （n=70, 52.2%） and sputum （n=38, 28.4%）. KlebsieUa pneumoniae was identified in samples from the department of neurosurgery, including neurosurgery ICU （47.8%, 64/134）, ICU （23.9%, 32/ 134）, department of hepatobiliary surgery （8.2%,11/134） and department of urology （6.0%, 8/134）. Among all 22 antimicrobial agents tested, the resistant rates of CRKP to 16 antimicrobial agents were 〉90%, especially for ampicillin it was 100%, and those to 19 antibiotics were 〉80%, only for tigeeyeline it was 23.1%. There were 16 strains of CRKP with positive extended spectrum β-1aetamases （ESBLs） （11.9%）. All the CRKP strains were resistant to more than three kinds of antimicrobial agents, except one strain that was resistant to two kinds. Conclusion There is a wide range of clinical distribution of CRKP, which is resistant to most of antimicrobial agents, while tigeeveline still has a strong antibacterial activity to CRKP.