产超广谱β―内酰胺酶肺炎克雷伯菌的检测及耐药性分析

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[摘要] 目的 调查中国医科大学附属盛京医院（以下简称“我院”）住院患者产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌的临床分布及耐药性，为临床医师抗感染治疗提供依据。 方法 收集2015年1～12月我院住院患者送检的各类标本，采用VITEK 2 Compact进行细菌鉴定和药敏试验，按照CLSI推荐的方法进行ESBLs初步筛选和表型确证试验，并对阳性患者耐药性进行分析。 结果 共检出产ESBLs肺炎克雷伯菌302株，其中痰液标本中检出最多，占38.74%，其次是全血和尿液，分别占28.81%和13.91%；科室分布以儿科和普通外科为主，分别占53.97%和7.95%。产ESBLs肺炎克雷伯菌对氨苄西林、头孢唑啉、哌拉西林、头孢曲松、头孢噻肟的耐药率均在95%以上，而对碳青霉烯类药物的耐药率较低，低于3%。 结论 住院患者产ESBLs肺炎克雷伯菌的耐药率高，治疗难度大，医师应根据药敏试验结果加强对抗生素的合理使用。

[关键词] 肺炎克雷伯菌；超广谱β-内酰胺酶；耐药性；病原菌

[中图分类号] R969.3 [文献标识码] A [文章编号] 1673-7210（2017）05（b）-0103-04

[Abstract] Objective To analyze the clinical distribution and drug resistance of extended-spectrum beta-lactamase （ESBLs）-producing Klebsiella pneumoniae in hospitalized patients in Shengjing Hospital Affiliated to China Medical University （"our hospital" for short）， in order to provide references for therapy of infections. Methods ESBLs-producing Klebsiella pneumoniae isolated in our hospital from January to December 2015 were collected. The bacteria identification and drug sensitivity test were performed by the VITEK 2 Compact. The ESBLs preliminary screening and the phenotypic confirmatory test were taken according to the guideline of CLSI， and at the same time， the results of the drug sensitivity test were analyzed. Results 302 strains of ESBLs-producing Klebsiella pneumoniae were isolated， which were mostly isolated from sputum samples （38.74%）， followed by blood （28.81%） and urine （13.91%）. The bacteria were mainly distributed in Paediatrics Department （53.97%） and General Surgery Department （7.95%）. The drug resistances of ESBLs-producing Klebsiella pneumoniae to Ampicillin， Cefazolin， Piperacillin， Ceftriaxone， Cefotaxime in hospitalized patients were more than 95%， and the resistance rate to carbapenemes was lower， less than 3%. Conclusion The isolated ESBLs-producing Klebsiella pneumoniae in hospitalized patients are highly resistant to the commonly used antibiotics， and the treatment is difficult. Therefore， the drug sensitive test should be strengthened to direct clinical rational use of antibiotics.

[Key words] Klebsiella pneumoniae； Extended spectrum beta-lactamases； Drug resistance； Pathogens

肺炎克雷伯菌V泛分布于自然界，是引起呼吸道感染重要的条件致病菌，其临床分离率在革兰阴性杆菌中居第3位[1-2]。产生超广谱β-内酰胺酶（extended-spectrum beta-lactamase，ESBLs）是肺炎克雷伯菌的主要耐药机制之一[3]，由其引起的感染在儿童及老年患者、免疫力低下的患者以及接受各种侵入性诊疗操作的重症患者中发病率高[4]。随着抗菌药物的广泛使用，尤其是第三代头孢菌素类药物在临床上的大量使用，使得产ESBLs肺炎克雷伯菌的耐药性不断上升[5]。因此，本研究收集2015年1～12月中国医科大学附属盛京医院（以下简称“我院”）住院患者送检的标本的培养结果，对其产ESBLs肺炎克雷伯菌的感染情况及其耐药特点进行回顾性分析，为临床合理选择抗产ESBLs肺炎克雷伯菌的药物提供参考依据，现报道如下：