矽肺并发肺部感染肺炎克雷伯菌的耐药性分析

目的了解矽肺患者院内肺部感染肺炎克雷伯菌及耐药情况,为治疗提供依据。方法对湖南省劳动卫生职业病防治所附属医院2008年4月至2009年10月临床检出菌进行鉴定及药敏分析,并用双纸片法对矽肺患者分离的肺炎克雷伯菌进行超广谱β-内酰胺酶(extend-spectrumβ-lactamases,ESBLs)检测,同时对产ESBLs及非产ESBLs菌株进行耐药性分析。结果矽肺并院内肺部感染患者总共检出肺炎克雷伯菌92株,其中检出ES-BLs阳性菌株58株,产酶率为63.04%。在12种抗生素中,耐药率最低的是亚胺培南。将19株ESBLs阴性的肺炎克雷伯菌平均耐药率与39株ESBLs阳性的肺炎克雷伯菌的平均耐药率相比较差异有统计学意义。结论矽肺等免疫力低下的患者是肺炎克雷伯菌的易感人群,且以呼吸道感染为主。治疗感染产ESBLs肺炎克雷伯菌的有效药物为抗生素与酶抑制的复方制剂和亚胺培南。

Analysis of the antimicrobial resistance of Klebsiella pneumoniae isolated from nosocomial pulmonary infection in silicosis patients

Objective To study the antimicrobial resistance of Klebsiella pneumoniae（K.pneumoniae）in silicosis patients as well as the application of clinical antibiotics.Methods The bacteria,which were isolated from April 2008 to October 2009 in the institute of Labor Health and Occupational Disease Prevention of Hunan Provincial Hospital,were indentified.The ESBLs in the isolated K.pneumoniae from silicosis patients were detected by means of double disk method,then we analysed the drug resistance of the ESBLs produces and nonproducers.Results 92 K.pneumoniae were isolated from silicosis patients,among which the percentage of producing ESBLs was 63.04%.The resistant rate of IPM was the lowest in the 12 antibiotics.The rate of drug resistance of the ESBLs producers was significantly higher than that of nonproducers,which is of statistical significance.Conclusion The patients of silicosis were easy to be infected by K.pneumoniae.IPM and the compound preparations of antibiotics and enzyme inhibitor are the effective drugs to treat the patients infected with ESBLs K.pneumoniae.