ICU与非ICU肺炎克雷伯菌的分布及耐药性分析

目的 对比重症监护病房(ICU)与非ICU感染肺炎克雷伯菌的临床分布、耐药及产ESBLs情况,为临床合理选用抗菌药物及控制医院感染提供依据.方法 采用法国生物梅里埃公司生产的VITEK-2型全自动细菌鉴定及药敏分析仪,对细菌进行鉴定及药敏试验,用WHONTE5.4软件分析病原菌的分离率及耐药率.结果 2008至2011年共分离肺炎克雷伯菌325株,其中ICU145株占44.6％,非ICU 180株占55.4％；产ESBLs的肺炎克雷伯菌株157株,占48.3％；ICU分离的肺炎克雷伯菌对阿米卡星、妥布霉素、哌拉西林/他唑巴坦的耐药率分别为16.6％、29.7％、29.7的％,而非ICU分别为10.0％、12.8％、11.7％；所有分离株均对亚胺培南保持100.0％的敏感率,肺炎克雷伯菌产ESBLs率在ICU为87.8％,显著高于非ICU的42.3％,差异有统计学意义(P＜0.01)；庆大霉素、头孢他啶、阿米卡星、氨曲南、哌拉西林、哌拉西林/他唑巴坦、替卡西林/克拉维酸、头孢曲松、头孢噻肟、头孢吡肟等,ICU分离株对以上药物的耐药率显著高于非ICU,差异均有统计学意义(P＜0.05).结论 ICU检出的肺炎克雷伯菌耐药率显著高于非ICU的菌株,尤其是产ESBLs率,应引起临床高度重视.

Distribution and drug resistance of Klebsiella pneumoniaein ICU and non-ICUs

OBJECTIVE To compare the clinical distribution,drug resistance and the production of ESBLs of Klebsiella pneumoniae in ICU and non-ICUs so as to provide bases for the reasonable use of antibiotics and the control of nosocomial infections.METHODS The identification of bacteria were performed by BioMerieux VITEK2 system and antibiotic susceptibility test was performed by adopting Kirby-Bauer method.The data of the isolation rates and drug resistance rates of the bacteria were analyzed by WHONET5.4 software.RESULTS Of totally 325 strains of K.pneumoniae isolated,145(44.6%) strains were from ICU and 180(55.4%) strains were from non-ICUs;there were 157(48.3%) strains of ESBLs-producing K.pneumoniae;the drug resistance rates of the strains isolated from ICU to amikacin,tobramycin,piperacillin/tazobactam were 16.6%,29.7%,and 29.7%,respectively,while the resistance rates of the strains isolated from non-ICUs to those antibiotics were 10.0%,12.8%,and 11.7%,respectively;all the isolates were susceptible to imipenem;the positive rate of ESBLs-producing K.pneumoniae in ICU was 87.8%,significantly higher than 42.3% in non-ICUs,the difference was statistically significant(P<0.01);the drug resistance rates to gentamicin,ceftazidime,amikacin,aztreonam,piperacillin,piperacillin/clavu lanic and,ticarcillin/clavulanicacid,cedtriaxone and cefotaxime of the isolates form ICU were significantly higher than those of the isolates from non-ICUs,the differences were statistically significant(P<0.05).CONCLUSION The detection rate of K.pneumoniae from ICU,ESBLs-producing strains,is significantly higher than that of the strains from non-ICUs,which is worthy of the attention.