肺炎克雷伯菌的分布及耐药性分析

Analysis of distribution and drug resistance of Klebsiella pneumoniae

目的分析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及控制感染。方法选取本院2016年1月至2018年12月临床分离的581株肺炎克雷伯菌作为研究对象。细菌培养严格按照《全国临床检验操作规程》进行操作。采用法国生物梅里埃公司自动鉴定药敏分析仪Vitek-2进行鉴定和药敏试验。结果 581株肺炎克雷伯菌主要分离自痰液标本,占53.2%。肺炎克雷伯菌对阿米卡星、亚胺培南、美洛培南、厄他培南耐药率最低,分别为5.51%、4.65%、4.13%和0.00%,对头孢唑啉耐药率为97.42%,对氨苄西林、阿莫西林耐药率最高,均为100.00%;581株肺炎克雷伯菌检出产超广谱β-内酰胺酶(ESBL)肺炎克雷伯菌94株,检出率为16.17%,产ESBL菌株耐药性增高,检出耐碳青霉烯类肺炎克雷伯菌(CRKP)27株,检出率为4.65%,对碳青霉烯类抗菌药物耐药性明显增加。结论肺炎克雷伯菌是呼吸道感染的常见病原菌,其耐药情况日趋严重,特别是CRKP的检出,应引起广大医务工作者的重视,产ESBL肺炎克雷伯菌耐药性增高,应加强规范合理使用抗菌药物。

Objective To analyze the distribution and drug resistance of Klebsiella in patients with clinical pneumonia in our hospital, and to guide the rational use of antibiotics and control infection. Methods The distribution and drug resistance rate of 581 strains of Klebsiella pneumoniae from January 2016 to December 2018 were selected as study subjects. Bacterial culture was carried out in strict accordance with the National Clinical Laboratory Procedures. Identification and susceptibility testing were carried out using the French BioMérieux Company’ s automatic identification of the drug sensitivity analyzer Vitek-2. Results 581 strains of Klebsiella pneumoniae isolated from sputum samples accounted for 53.2%. Klebsiella pneumoniae had the lowest resistance rates to amikacin, imipenem, meropenem, and ertapenem, which were 5.51%, 4.65%, 4.13%, and 0.00%, respectively. The resistance rate to cefazolin reached 97.42%, and the highest resistance rate to ampicillin and amoxicillin were both 100.00%. 581 strains of Klebsiella pneumoniae detected more than 94 strains of broad-spectrum β-lactamase(ESBL) Klebsiella pneumoniae, with a detection rate of 16.17%. The resistance of ESBL strains increased. The detection rate of 27 carbapenem-resistant Klebsiella pneumoniae(CRKP) was 4.65%, and its resistance to carbapenems was significantly increased. Conclusion Klebsiella pneumoniae is a common pathogen of respiratory infections. Due to the increasingly serious drug resistance, especially the detection of CRKP, it should be paid attention to by the majority of medical workers. The drug resistance of ESBL-producing Klebsiella pneumoniae is increased, and the rational use of antibiotics should be strengthened.