院内感染肺炎克雷伯杆菌的耐药性及其产ESBLs研究

目的 :监测肺炎克雷伯杆菌对 17种常用抗生素的耐药性及其产ESBLs菌株院感情况。方法 :收集、分离、鉴定肺炎克雷伯杆菌。用K -B纸片扩散法进行药敏实验 ,并按NCCLS推荐方法检测产ESBLs菌株。结果 :共分离到 12 8株非重复肺炎克雷伯杆菌 ,其中产ESBLs株 6 0株 ,占 4 6 .88%。产ESBLs菌株对 17种抗生素的耐药率分别为氨苄青霉素 10 0 %、哌拉西林 96 .7%、奥格门丁 4 2 .6 %、舒普深 4 7.2 %、头孢唑啉 96 .7%、头孢呋新 96 .7%、头孢他啶 18.3%、头孢噻肟 71.7%、氨曲南 4 3.3%、亚胺培南 0 %、环丙沙星 31.7%、庆大霉素 86 .7%、阿米卡星 6 6 .7%、萘啶酸 6 6 .7%、氯霉素 6 1.5 %、四环素 6 4 .9%、头孢吡肟 36 .1% ;不产ESBLs菌株对上述大多数抗生素的耐药性较低 ,与产ESBLs菌株的耐药性比较除氨苄青霉素、亚胺培南外 ,其他均有显著性差异 ,P <0 .0 1。结论 :亚胺培南是治疗产ESBLs肺炎克雷伯杆菌菌株感染的首选药物。肺炎克雷伯杆菌的耐药株日趋增多 ,应采取措施控制肺炎克雷伯杆菌引起的医院感染流行。

Antimicrobial resistance of Klebsiella pneumoniae and the nosocomial infection of ESBLs-producing strains

Objective To survey the drug-resistance of Klebsiella pneumoniae to 17 kinds of antibiotics and the nosocomial infection of ESBLs-producing strains. Methods After Klebsiella pneumoniae was collected, isolated and identified, drug-resistance experiment was measured with K-B method and ESBLs-producing strains detected according to NCCLS recommended method. Results Unrepeatable 128 strains of Klebsiella pneumoniae were obtained from ShiYan city, 60 of which were ESBLs-producing(46.88%), its drug-resistance rate of Klebsiella pneumoniae to Ampicillin, Pipercillin, Amoxicillin-clavuanic acid, Sulbactam-cefoperazona, Cefazolin, Cefuroxime sodium, Ceftazidime, Cefotaxime, Aztreonam, Imipenem, Ciprofloxacin, Gentamicin, Amikacin, Nalidixicacid, Chloramphenicol, Tetracycline, Cefepime were 100%, 96.7%, 42.6%, 47.2%, 96.7%, 96.7%, 18.3%, 71.7%, 43.3%, 0%, 31.7%, 86.7%, 66.7%, 66.7%, 61.5%, 64.9%, 36.1%, respectively. The drug-resistance rates of ESBLs-producing strains were significantly different from the EBSLs-nonproducing strains ( P <0.01) with the exception of Imipenem and Ampicillin. Conclusion Imipenem may be the first choice to treat the infection of EBSLs-producing strain of Klebsiella pneumoniae . Measures should be taken to prevent the nosocomial infection of Klebsiella pneumoniae.