2011年昆明医科大学第一附属医院肺炎克雷伯菌耐药性监测

目的调查昆明医科大学第一附属医院2011年肺炎克雷伯菌的耐药性,以指导临床合理使用抗菌药和预防院内感染。方法回顾性分析昆明医科大学第一附属医院2011年检出的肺炎克雷伯菌的耐药情况,并与2010进行比较分析。结果 2011年昆明医科大学第一附属医院的临床标本中分离到3878株细菌,其中肠杆菌科细菌1765株中包括,肺炎克雷伯菌483株,占全部分离菌株的12.5%,占肠杆菌科细菌的27.4%,大部分来自呼吸道标本,呼吸道标本检出269株(占55.7%),其次为尿标本,检出103株(占21.3%)。2011年检出的肺炎克雷伯菌对头胞哌酮舒巴坦的耐药率,产ESBLs的为10.1%,不产ESBLs的为2.8%,而对亚胺培南的耐药率,产ESBLs的为3.0%,不产ESBLs的为6.8%,对美罗培南的耐药率,产ESBLs的为4.0%,不产ESBLs的为6.2%,产ESBLs的肺炎克雷伯菌对阿莫西林-卡拉维酸和丁胺卡那的耐药率分别为36.1%和37.1%,2010年肺炎克雷伯菌对亚胺培南和美罗培南无耐药菌株。结论昆明医科大学第一附属医院肺炎克雷伯菌对头胞哌酮舒巴坦及碳青霉烯类抗菌药物仍保持较高的敏感性,但对其余抗菌药物的耐药率仍明显。应加强细菌耐药监测,指导临床合理使用抗菌药物,加强感染控制措施,预防和控制耐药菌株的院内流行。

The First Affiliated Hospital of Kunming Medical University 2011 Surveillance of Antimicrobial Resistance in Klebsiella pneumoniae

Objective To investigate the antimicrobial resistance of Klebsiella pneumoniae isolated from patients in the First Affiliated Hospital of Kunming Medical University during 2011 to guide the rational use of antimicrobial and prevent the nosocomial infection.Methods Clinical isolates of K.pneumoniae were retrospectively analyzed and compared to the 2010 situation.Results Of the 3878 clinical strains collected,there were 1765 strains of enterobacteriaceae,K.pneumoniae was 483 strains(12.5% of the total,27.4% of enterobacteriaceae),and 55.7%(269 strains)were isolated from respiratory tract,followed by urine sample,from which 103 strains were isolated(21.3%).The percentage of 2011 K.pneumoniae(ESBLs-producing strains)resistant to cefoperazone-sulbzctam was 10.1%.The percentage of K.pneumoniae(non-ESBLs-producing strains)resistance was 2.8%.Resistance to Imipenem,Meropenem,Amoxicillin-clavulanic acid and Anikacin of the ESBLs-producing strains was 3.0%,4.0%,36.1%,37.1% respectively.And the resistance to Imipenem,Meropenem of Imipenem,Meropenem was 6.8%,6.2% respectively.There was no K.pneumoniae resistant to Imipenem and Meropenem in 2010 tested strains.Conclusion Carbapenems and cefoperazone-sulbactam are still highly active against K.pneumoniae.But the antimicrobial resistance of K.pneumoniae is still a serious problem in our hospital.The surveillance of antimicrobial resistance is very important for guiding rational antimicrobial therapy.The infection control should be strengthened to prevent the spread of drug-resistant strains in the hospital.