耐碳青霉烯类肺炎克雷伯菌的表型分析

目的分析昆山市中医医院临床分离肺炎克雷伯菌病原株的分布及耐药情况,并对分离耐碳青霉烯类肺炎克雷伯菌(CRKP)的主要耐药机制进行初步分析,为临床抗菌治疗及院内感染控制提供依据。方法采用VITEK-2 compact微生物鉴定及药敏系统对临床分离菌株进行鉴定和药敏测定,对其分布及耐药情况进行统计分析。对临床初筛的CRKP菌株进行K-B药敏试验、表型确证试验(改良Hodge试验)、产超广谱-内酰胺酶(ESBLs)确证试验以及检测AmpC酶的三维试验。结果临床分离的295株克雷伯菌中有CRKP 23株,主要来源于痰标本,送检科室以ICU为主;其中AmpC阳性12株,ESBLs阳性6株,2种酶均为阳性2株;CRKP大部分来自重症老年患者;CRKP的多重耐药性明显高于非耐碳青霉烯类肺炎克雷伯杆菌(CSKP)(P<0.05),对环丙沙星、左氧氟沙星、妥布霉素和丁胺卡那霉素的耐药率低于50.00%,而既产AmpC酶又产ESBLs的菌株对上述4种抗生素敏感。结论CRKP的多重耐药性明显高于CSKP,其中产AmpC酶CRKP的检出率比产ESBLs更高,治疗由CRKP所致感染时,应根据其药敏检测结果,选用耐药性较低的抗生素治疗,如环丙沙星、左氧氟沙星、妥布霉素和丁胺卡那霉素等。

Phenotypic analysis of carbapenem-resistant Klebsiella pneumoniae

Objective To analyze the distribution and drug resistance of Klebsiella pneumoniae isolates in Kunshan Traditional Chinese Medical Hospital,to analyze the main drug resistance mechanism of carbapenem-resistant Klebsiella pneumoniae(CRKP),and to provide the basis for clinical drug treatment and nosocomial infection control.Methods The clinical isolates were identified and tested by VITEK-2 compact microbiological identification and drug susceptibility system.The distribution and drug resistance were then analyzed.The clinical screening of CRKP strains were tested by K-B susceptibility test and phenotype confirmation test,including modified Hodge test for carbapenemase,confirmation test for ESBLs,and modified three-dimensional extract test for AmpC enzyme.Results 23 strains of CRKP,mainly from sputum,were isolated from 295 strains including 12 AmpC positive strains,6 ESBLs positive strains and 2 both positive strains;CRKP were mainly derived from elderly patients with severe disease;the multiple drug resistance of CRKP was significantly higher than CSKP(P<0.05).In ciprofloxacin,levofloxacin,tobramycin and amikacin,drug resistance of CRKP was less than 50.00%;strains producing both AmpC enzymes and ESBLs were sensitive to these 4 drugs.Conclusion The multiple drug resistance of CRKP was significantly higher than that of CSKP;The AmpC positive strains were found more than the ESBLs positive strains;clinical treatment of infection by CRKP should select low resistance to antibiotics,according to the drug sensitivity test results,such as ciprofloxacin,levofloxacin,tobramycin and amikacin.