肺炎克雷伯菌的耐药状况分析

目的了解肺炎克雷伯菌对常用抗生素的耐药状况，为临床使用抗生素治疗肺炎克雷伯菌感染提供依据。方法用Vitek自动化细菌鉴定及药敏分析系统对菌落进行鉴定并做药敏，对检出的肺炎克雷伯菌的药敏结果做一分析。结果在149份检出有目的菌的标本中，痰液标本占91．3％，其他少量标本为尿液、伤口分泌物等标本。有43株肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs），产酶率为28．9％。产酶株对青霉素类、第1～3代头孢100％耐药，对头孢吡肟、头孢西丁的敏感率分别为9．3％、58．1％；阿莫西林及哌拉西林与加酶抑制剂复合剂的抑菌效果虽有明显提高，但其敏感率却均未超过60．0％，替卡西林及其与棒酸的复合剂的抑菌效果不佳，敏感率均低于5．0％；阿米卡星的敏感性好，敏感率达81．4％，仅次于美罗培南（100％）与亚胺培南（100％）。非产酶株除青霉素外对其他常用抗生素的敏感性普遍强于产酶株，加酶抑制剂复合剂的抑菌效果好。结论产ESBLs肺炎克雷伯菌耐药性严重，美罗培南、亚胺培南、阿米卡星可作为治疗产ESBLs株感染的首选药物，而β-内酰胺酶类加酶抑制剂、阿米卡星、3代头孢是治疗非产ESBLs株感染有效的药物。因此。临床根据药物敏感性试验合理用药很关键。

Distribution and resistance analysis of Klebsiella pneumoniae

Objective To investigate the resistance characteristic of Klebsiella pneumoniae in order to provide reference for the clinical application of antibiotics, Methods The strains of Klebsiella pneumoniae were detected and their sensitivity to antibiotics were determined by Vitek automatic bacterium identifying and drug sensitivity analyzing systems, and the result of sensitivity to antibiotics were analyzed, Results Among 149 specimens in which Klebsiella pneumoniae were detected, the sputum was most frequent （91.3 % ）, the others included urine and incisional secretion. There were 43 strains which produced extended- spectrum β -lactamases （ESBLs） , the ESBLs -producing rate of Klebsiella pneumoniae was 28.9%. The resistant rate of the ESBLs producers against penicillins and the antibiotics from the first generation cephalosporins to the third generation ones were all 100% , and the susceptibility rate to cefepime, cefoxitine were 9.3% and 58.1% respectively. The sensitivity of ESBLs producers to penicinins combined with the β - lactamases inhibitors rose obviously, but the susceptibility rates were less than 60.0% respectively. The sensitivity of ESBLs producers to amikacin,imipenem and meropenem were good, the susceptibility rates were 81.4% , 100% and 100% respectively. The sensitivity of the non - ESBLs producers to the other antibiotics but penicillins were higher than that of the ESBLs producers, peni- cillins combined with the β - lactamases inhibitor had more activated. Conclusion It is rather serious the resistance of Klebsiella pneumoniae which produced ESBLs to the usual antibiotics, and imipenem, meropenem and an~ikacin were very effectual drugs to treat infections caused by ES- BLs producers, while the complex antibiotics containing β - laetaruases inhibitor, anfikacin and the third generation eephalosporins were very effectual drugs to treat infections caused by non - ESBLs producers. It is very important to select rational drugs correctly for clinical treatment of the infections according t