血液净化中心肺炎克雷伯菌血流感染调查分析

Investigation of bloodstream infections caused by Klebsiella pneumoniae at a blood purification center

目的调查血液净化中心肺炎克雷伯菌血流感染情况,以指导临床抗感染预防与治疗。方法收集171例血液净化中心血流感染肺炎克雷伯菌患者资料。分析肺炎克雷伯菌耐药性,并对菌株进行血清分型。结果患者感染来源为肺部感染、原发性菌血症、胆道感染、泌尿系统感染、其他感染源的患者数分别为18.38.31.44和40例,分别占10.53%、22.22%、18.13%、25.73%和23.39%。研究中共分离171株肺炎克雷伯菌,其中69株产ESBLs株,11株碳青霉烯耐药菌株。肺炎克雷伯菌对氨苄西林、哌拉西林、氨苄西林/舒巴坦、哌拉西林/三唑巴坦、头孢呋辛酯、头孢噻肟、头孢他啶、头孢西丁、头孢吡肟、氨曲南、庆大霉素、妥布霉素、阿米卡星、紅霉素、四环素、复方新诺明、诺氟沙星环丙沙星、加替沙星、阿莫西林、阿米卡星、美罗培南和亚胺培南的耐药率分别为100%、46.78%、27.49%、17.54%、42.69%、41.52%、26.90%、26.32%、24.56%、41.52%、56.73%,51.46%.5.85%.71.93%、69.59%、54.39%、51.46%、40.94%、7.02%、64.91%.4.68%.6.43%和5.26%。耐药性检测中,产ESBLs菌株对,上述临床常用药物耐药性高于非产ESBLs菌株;碳青霉烯耐药株对上述临床常用药物耐药性高于敏感菌株。171株肺炎克雷伯菌中,40株黏液丝试验阳性,占23.39%,即HMVKP为40株(23.39%),CKP为131株(76.61%)。血清分型结果显示,K1型15株(8.77%),K2型19株(11.11%),其他分型12株(7.02%)。结论肺炎克雷伯菌分型以K1、K2为主;临床治疗肺炎克雷伯菌感染时,可以合理使用亚胺培南。

Objective To investigate bloodstream infections caused by K.pneumoniae at a blood purification center in order to guide the clinical prevention and treatment of infection.Methods Clinical data on 307 patients at a blood purifi-cation center were collected,and venous blood samples were collected to identify pathogen types.The drug resistance of K.pneumoniae was analyzed and the isolates were serotyped.Results Eighteen patients(10.53%)had a pulmonary infection,38(22.22%)had primary bacteremia,31(18.13%)had a biliary tract infection,44(25.73%)had a urinary tract infection,and 40(23.39%)had an infection from some other source.A total of 171 K.pneumoniae strains were i-solated,69 of which were ESBL-producing strains and 11 of which were carbapenenm-resistant strains.The resistance of Klebsiella pneumoniae to ampicillin was 100%,its resistance to piperacilin was 46.78%,its resistance to ampicillin/sul-bactam was 27.49%,its resistance to piperacillin/tazobactam was 17.54%,its resistance to cefuroxime axetil was 42.69%,its resistance to cefotaxime was 41.52%,its resistance to ceftazidime was 26.90%,its resistance to cefoxitin was 26.32%,its resistance to cefepime was 24.56%,its resistance to aztreonam was 41.52%,its resistance to gentamicin was 56.73%,its resistance to tobramycin was 51.46%,its resistance to amikacin was 5.85%,its resistance to erythro-mycin was 71.93%,its resistance to tetracycline was 69.59%,its resistance to compound minocycline was 54.39%,its resistance to norfloxacin was 51.46%,its resistance to ciprofloxacin was 40.94%,its resistance to gatifloxacin was 7.02%,its resistance to amoicilin was 64.91%,its resistance to amikacin was 4.68%,its resistance to meropenem was 6.43%,and its resistance to imipenem was 5,26%.In a drug resistance test,ESBL-producing strains were more resist-ant to the commonly used antibiotics listed above than were non ESBL producing strains.Carbapenem-resistant strains were more resistant to the commonly used antibiotics listed above than were sensitive strains.Of 171 strains of K.pneu-moniae,40(23.39%)resulted in a positive string test.There were 40 strains of HMVKP(23.39%)and 131 strains of CKP(76.61%).Serotyping indicated that 15 strains were the K1 type(8.77%),19 were the K2 type(11.11%),and 12 were some other type(7.02%).Conclusion The types of K.pneumoriae were mainly K1 and K2.Imipenem can be rationally used to clinically treat a K.pneumoniae infection.