美罗培南非敏感多重耐药肺炎克雷伯菌败血症临床治疗结果分析

目的评估可疑产碳青霉烯酶肺炎克雷伯菌多重耐药菌株败血症抗生素治疗方法。方法收集2011年10—11月本院术后感染发热患者（男9例，女9例）分离的肺炎克雷伯菌，常规药敏试验测定菌株最小抑菌浓度（MIC），改良Hodge法检测碳青霉烯酶，回顾性分析患者临床资料。结果18株KPN为多重耐药菌株，耐药表型对所有三代头孢菌素耐药，对四代头孢菌素头孢吡肟敏感或中介；碳青霉烯酶试验阳性，产金属β-内酰胺酶（MBLs）试验阳性。药敏试验回报前经验用药抗菌治疗；药敏结果报告后，3例患者药敏结果显示经验用药药物敏感，继续用该药治疗，抗菌治疗7—12d；2例患者合并念珠菌感染；其余13例患者，在药敏结果报告后改用亚胺培南／西司他丁钠，治疗3—5d后，白细胞计数、体温即恢复正常。结论对于临床可疑产碳青霉烯酶的多重耐药KPN菌株感染，临床是否可以继续使用该类药物治疗，药敏试验结果仍是主要依据，与碳青霉烯酶（可降解碳青霉烯类药物）的产生与否无直接关系。

Clinical therapeutic Results of meropenem on non-sensitive multidrug resistant klebsiella pneumoniae bacteremia

Objective To evaluate the antibiotic treatment method of septicaemia infected by carbapenemase - produced klebsiella pneumoniae （KPN） multi - drug resistant strains. Methods KPN were isolated from 18 patients with fever caused by postoperative infection （9 male ones and 9 female ones） from October to November 2011. The minimal inhibitory concentration of the strain was detected by conventional susceptibility test, and carbapenemase was detected by the improved Hodge method. The clinical data of those patients were retrospectively analyzed. Results All the 18 isolated KPN strains were muhidrug resistant. The phenotype was drug resistant to all the tert - cephalosporin, susceptive or mesomeric to the quadr - cephalosporin cefeprime. The carbapenemase and the produced metal - 13 - lactamase （MBLs） were positive. Before the susceptibility test results came out, empirical antibiotic treatment was carried out. After the reports returned, the results showed that 3 patients were sensitive to the empirical antibiotic drugs and continuously received the above antibiotic treatment for 7 - 12 d; 2 ones had the combination of monilia infection; other 13 ones changed their drugs based on the report of antimicrobial susceptibility test and received the treatment with cilastatin for 3 - 5 d, and their lencocyte count and body temperature became normal. Conclusion The susceptibility test result is the main basis to identify whether antibiotic drugs can be used in the treatment of infection caused by the carbapenemase - produced KPN multi - drug resistant strain.