61例血流感染肺炎克雷伯菌耐药性分析

Analysis of drug resistance of klebsiella pneumoniae in 61 patients with bloodstream infection

目的 了解佛山市某医院住院患者血流感染病例中肺炎克雷伯菌的分布及耐药性,指导临床合理使用抗菌药物.方法 回顾性调查2015年1月1日至2017年12月31日住院患者血流感染中肺炎克雷伯菌的分布和耐药性,用常规方法培养分离,K-B法进行药敏试验.依据当年最新CLSI标准判读结果.结果 共检出肺炎克雷伯菌61株,以肿瘤血液病和ICU为主,分别占21.3%和19.7%.肺炎克雷伯菌对氨苄西林耐药率达95%以上,对美罗培南、亚胺培南、阿米卡星敏感性较好.产ESBLs菌株检出率为25.4%(15/61),其耐药率明显高于非产ESBLs菌株.仅2017年检出3例耐碳青酶烯的菌株,对替加环素和多粘菌素敏感.结论 血流感染中分离的肺炎克雷伯菌耐药情况严重,产ESBLs和耐碳青酶烯的菌株增多,临床医师应合理应用抗生素,以提高临床治疗效果.

Objective To understand the distribution and drug resistance of klebsiella pneumoniae in patients with bloodstream infection in a hospital in Foshan,and to guide the rational use of antibiotics in clinical practice.Methods The distribution and drug resistance of klebsiella pneumoniae in hospitalized patients with bloodstream infection from January 1,2015 to December 31,2017 were retrospectively investigated.The klebsiella pneumoniae was cultured and isolated by conventional methods,and the drug sensitivity test was conducted by K-B method.The results were interpret according to the latest CLSI standard.Results 61 strains of klebsiella pneumoniae were detected,mainly from tumor hematopathy and ICU,accounting for 21.3% and 19.7%,respectively.More than 95% of klebsiella pneumoniae were resistant to ampicillin,but were sensitive to meropenem,imipenem,and amikacin.The detection rate of ESBLs producing strains was 25.4% (15/61),and whose drug resistance rate was significantly higher than that of non-ESBLs producing strains.Only 3 cases of carbapenem-resistant strains were detected in 2017,which were sensitive to tigecycline and polymyxin.Conclusion The drug resistance of klebsiella pneumoniae isolated from bloodstream infection is serious,and the strains producing ESBLs and carbapenem-resistant are increasing.Clinicians should apply antibiotics reasonably to improve the clinical treatment effect.