连续12年产超广谱β-内酰胺酶肺炎克雷伯菌感染分布及耐药性分析

目的了解产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌（KPN）的临床分布及耐药性,为临床合理选用抗菌药物提供依据。方法用常规方法,结合法国梅里埃公司的自动化细菌鉴定分析仪分离鉴定细菌;用K-B纸片扩散法进行药敏试验;用双纸片协同筛选法和酶抑制剂增强纸片法检测ESBLs。对中国医科大学附属盛京医院1999年1月至2010年12月期间临床分离的产ESBLs和非产ESBLs KPN菌株的临床分布及其耐药趋势进行回顾性分析。结果 KPN的ESBLs检出率分别从1999年的19.82%上升至2010年的49.34%;KPN主要分离于痰占52.4%,其次是血液占17.74%,主要来源于外科病区和新生儿病区;产ESBLs菌和非产ESBLs菌对阿米卡星、左氧氟沙星等非β-内酰胺酶类抗菌药物的耐药率均显著增高,差异具有统计学意义（P〈0.01）,对亚胺培南和美罗培南都保持高度敏感,耐药率均低于2%。结论 12年间ESBLs检出率总体呈上升趋势,产ESBLs肺炎克雷伯菌表达对包括非β-内酰胺类在内的抗菌药物多重耐药,对碳青霉烯类抗菌药物仍保持高度敏感性。

Extended-spectrum β-lactamases-producing Klebsiella pneumoniae:distribution of clinical infection and antibiotic resistance during 1999-2010

Objective To study the clinical distribution and the drug resistance of extended-spectrum β-lactamases(ESBLs) producing Klebsiella pneumoniae(KPN) and provide a basis for reasonable use of antibiotics in clinical practice.Method KPN was cultured and identified by routine method,API and VITEK2 system.Antimicrobial resistance was determined by Kirby-Bauer method.Double-disc synergy test and disk diffusion confirmatory test were used to detect extended-spectrum β-lactamase(ESBLs).The drug resistance trend and clinical distribution of ESBL-producing and non-ESBL-producing K.pneumoniae strains were retrospectively analyzed from Shengjing Hospital of China Medical University from Jan.1999 to Dec.2010.Result The ESBL-producing rates of K.pneumoniae increased from 19.82% in 1999 to 49.34% in 2010.K.pneumoniae was mostly isolated from sputum(52.4%) and blood(17.74%);22.56% from surgical wards and 19.81% from neonate wards.Compared with non-ESBL-producing K.pneumoniae,the rates of drug resistance of ESBL-producing K.pneumoniae to non β-lactam antibiotics such as amikacin and levofloxacin significantly increased(P<0.01).K.pneumoniae had the lowest resistance(<2%)to imipenem and meropenem.Conclusion The ESBL-producing rates of K.pneumoniae increased during the past 12 years.The ESBL-producing K.pneumoniae show multi-drug resistance to antibiotics including non β-lactam antibiotics.Carbapenems remain most active against strains of K.pneumoniae.