分离自下呼吸道感染患者的肺炎克雷伯菌耐药性调查

目的了解下呼吸道感染致病菌肺炎克雷伯菌对临床常用抗感染药物的耐药现状，为临床合理使用抗感染药物提供依据。方法采集下呼吸道感染住院患者送检的1528份痰培养标本中分离所得的肺炎克雷伯菌（同一患者分离多株的按1株计），采用法国梅里埃ATB—Expression分析仪进行细菌鉴定，K-B法做药物敏感试验，并同时用双纸片扩散法确证试验检测超广谱p内酰胺酶（ESBLs）。结果下呼吸道感染患者送检的1528份痰培养标本中分离培养出病原菌1004株，其中肺炎克雷伯菌177株，占17．6％。产ESBLs的肺炎克雷伯菌检出率为40．1％（71／177）。药物敏感试验显示产ESBLs肺炎克雷伯菌对常见抗感染药物呈多重耐药性，耐药率〉50％的抗感染药物有氨苄西林（93．0％）、哌拉西林（91．5％）、复方新诺明（88．7％）、头孢呋辛（85．9％）、头孢噻肟（80．3％）、庆大霉素（73．2％）、环丙沙星（64．8％）、头孢他啶（60．6％）、头孢吡肟（53．5％），耐药率〈50％的抗感染药物有哌拉西林他唑巴坦（29．6％）和阿米卡星（23．9％），而对亚胺培南和美罗培南敏感率为100．0％，产ESBLs菌株对抗感染药物的耐药率高于非产ESBLs菌株。结论肺炎克雷伯菌具有多重耐药性，临床应加强对肺炎克雷伯菌的耐药性监测，依据药敏试验结果合理使用抗菌药物，亚胺培南和美罗培南是治疗的有效药物。

Analysis of drug resistance and clinical drug use countermeasures of klebsiella pneumoniae from lower respiratory tract infection

Objective To investigate the drug resistance of klebsiella pneumoniae in the lower respiratory tract infection to guide the rational use of antibiotics. Methods ATB-expression analyzer was used to identify the microbe. The drug susceptibility was tested with the K-B method and the Extended-spectruml3-1actamases （ESBLs） producing strains detected by diffusion confirmed test. Results A total of 1528 strains of klebsiella pneumoniae were isolated from 177 specimens and 40.1% of them（71 strains） produced ESBLs. Results showed that the drug sus- ceptibility of ESBLs-producing klebsiella pneumoniae antimicrobial resistance in common multiple of imipenem （0. 0% ）, meropenem（0.0% ）, amikacin（23.9% ）, piperacillin/tazobactam（29.6% ） and cefoxitin（31.0% ） respectively. The drug resistance rate of ESBLs producing klebsiella pneumoniae was higher than that in non-producing ESBLs. Conclusions Klebsiella pneumoniae possesses multi-drug resistance. The clinician should strengthen monitoring of it and rationally use the antibiotics according to the result of antimicrobial susceptibility test. It is important to control nosocomial infection using imipenem and meropenem.