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目的了解住院肝病患者肺部感染肺炎克雷伯菌及其耐药情况,为临床合理应用抗菌药物提供依据。方法通过细菌分离鉴定和药敏试验方法,对山东某传染病专科医院住院肝病患者送检痰标本进行病原菌检测和分析。结果从65例住院肝病并发肺部感染患者痰标本中分离出65株肺炎克雷伯菌,其中检出产超广谱β-内酰胺酶菌株(ESBLs)21株,占32.31%。从痰液分离的肺炎克雷伯菌对18种临床常用抗菌药物均不同程度耐药,产ESBLs菌株耐药率明显高于非ESBLs菌株。临床分离的肺炎克雷伯菌仅对亚胺培南/西司他丁和美罗培南等碳青霉烯类比较敏感。结论住院肝病患者肺部感染的肺炎克雷伯菌中产ESBLs菌株比例较高,耐药严重,仅对碳青霉烯类抗菌药物敏感,提示应根据药敏试验结果选用抗菌药物。
Objective To understand the pulmonary infection of Klebsiella pneumoniae and its drug resistance in hospitalized patients with liver disease, and to provide a basis for rational use of antibiotics in clinical practice. Methods Bacterial isolation and identification and drug susceptibility testing methods were used to detect and analyze the pathogenic bacteria in hospitalized patients with liver disease from an infectious disease specialist hospital in Shandong Province. Results 65 strains of Klebsiella pneumoniae were isolated from the sputum of 65 patients with hospital-acquired liver disease complicated with pulmonary infection. Among them, 21 strains of ESBLs were detected, accounting for 32.31%. Klebsiella pneumoniae isolated from sputum were resistant to 18 kinds of commonly used antimicrobials, and the rate of ESBLs-producing strains was significantly higher than that of non-ESBLs strains. Klebsiella pneumoniae, which is clinically isolated, is only sensitive to carbapenems such as imipenem / cilastatin and meropenem. Conclusions The majority of ESBLs-producing strains of Klebsiella pneumoniae inpatients with inpatient liver disease are highly resistant and are only sensitive to carbapenem-based antimicrobial drugs, suggesting that antimicrobial agents should be selected according to the susceptibility test results.