2016—2018年蚌埠市第一人民医院肺炎克雷伯菌的分布及耐药性分析

目的 分析蚌埠市第一人民医院临床不同标本、不同科室、不同年龄患者分离的肺炎克雷伯菌的耐药情况，为肺炎克雷伯菌的预防和控制提供依据。方法 收集蚌埠市第一人民医院微生物室2016年1月—2018年12月各类临床标本分离的肺炎克雷伯菌，采用生物梅里埃公司Phoenix 100全自动细菌鉴定/药敏仪进行细菌的鉴定和药敏。结果 在检出的382株肺炎克雷伯菌中，分离率居前4位的标本来源是痰液266株（69.6%）、中段尿43株（11.3%）和血液30株（7.9%）；ICU和呼吸内科的分离率最高，分别占34.3%、23.6%；其次是心内科42株，占11.1%；儿科40株，占10.5%；≥65岁患者的分离率最高，占58.9%。其次是15～64岁患者，占31.4%；14岁以下患者最少，占9.7%；肺炎克雷伯菌对氨曲南、头孢他啶、头孢吡肟、左旋氧氟沙星、氨比西林舒巴坦在不同标本、不同科室及不同年龄患者中的耐药率差异显著（P<0.05）；对头孢哌酮舒巴坦、头孢西丁、阿米卡星、亚胺培南、美罗培南的耐药率较低且无统计学差异。结论 通过对临床分离的肺炎克雷伯菌耐药率从不同标本、不同科室、不同年龄患者3个角度进行分析，可以更好的指导临床合理用药，有效的预防和控制耐药菌的蔓延。

Distribution and drug resistance of Klebsiella pneumoniae in the First People's Hospital of Bengbu from 2016 to 2018

Objective To analyze the drug resistance of Klebsiella pneumoniae isolated from different clinical specimens, departments and patients of different ages in the First People''s Hospital of Bengbu, ad in order to provide the basis for the prevention and control of K. pneumoniae. Methods K. pneumoniae isolated from clinical specimens from January 2016 to December 2018 in the microbiology laboratory of the First People''s Hospital of Bengbu were collected. The bacteria were identified and susceptible to antibiotics by Phoenix 100, an automatic bacterial identification/drug susceptibility instrument of BioMerier Company. Results A total of K. pneumoniae (382 strains) were detected, in which 266 strains (69.6%) were isolated from sputum, 43 strains (11.3%) were from midstream urine, and 30 strains (7.9%) were from blood. ICU and respiratory medicine had the highest isolation rates, accounting for 34.3% and 23.6%, respectively, followed by cardiology (42 strains), accounting for 11.1% and pediatrics (40 strains), accounting for 10.5%. The highest isolation rate was 58.9% in patients over 65 years old. Secondly, patients of 15-64 years old accounted for 31.4%, and those under 14 years old accounted for 9.7%. The drug resistance rates of K. pneumoniae against aztreonam, ceftazidime, cefepime, levofloxacin, and ampicillin sulbactam to in different samples, departments and patients of different ages were significantly different (P<0.05). The drug resistance rates of K. pneumoniae against cefoperazone sulbactam, cefoxitin, amikacin, imipenem, and meropenem in different samples, different departments and different age groups were lower and there was no statistical difference. Conclusion Through the analysis of drug resistance rate of K. pneumoniae isolated from clinical samples, departments and patients of different ages, clinical rational drug use can be better guided to effectively prevent and control the spread of drug-resistant bacteria.