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目的分析致ICU与非ICU患者下呼吸道感染肺炎克雷伯菌的耐药性差异,为临床科学选用抗菌药物,有效控制感染提供科学依据。方法对2012年1月至2014年12月从临床下呼吸道标本中分离的肺炎克雷伯菌582株进行比较分析,常规方法分离培养肺炎克雷伯菌,采用K-B纸片法进行药敏试验,利用WHONET 5.6软件分析处理实验数据。结果检测菌株582株,其中ICU分离208株,占35.7%,非ICU分离374株,占64.3%;从ICU中分离出的肺炎克雷伯菌的耐药率除头孢替坦外明显高于非ICU,两者差异有统计学意义(P<0.05);两者对氨苄西林、头孢唑林、头孢呋辛的耐药率都较高,均>40.0%,对头孢替坦、阿米卡星、亚胺培南、美罗培南都较敏感,耐药率<25.0%;产ESBLs率ICU和非ICU分别为70.7%和40.4%,两者差异有统计学意义(P<0.05)。结论从ICU中分离的肺炎克雷伯菌产ESBLs率高,且对18种抗菌药物耐药率明显高于非ICU,应用抗菌药物治疗该菌感染时,必须依据药敏试验结果,临床应加强对肺炎克雷伯菌的耐药性监测,了解其耐药趋势,减少耐药菌株的产生。
Objective To analyze the difference of drug resistance of Klebsiella pneumoniae in lower respiratory tract infection in patients with ICU and non-ICU, and to provide scientific basis for selection of antibacterial drugs in clinical science and effective control of infection. Methods 582 strains of Klebsiella pneumoniae isolated from clinical lower respiratory tract specimens from January 2012 to December 2014 were compared and analyzed. Klebsiella pneumoniae was isolated and cultured by routine methods. Drug susceptibility test was performed by using KB paper method. Analyze experimental data using WHONET 5.6 software. Results 582 isolates were detected, of which 208 were ICU isolates (35.7%) and 374 isolates were non-ICU (64.3%). The Klebsiella pneumoniae isolates isolated from ICU were more resistant than cefotetan ICU, the difference was statistically significant (P <0.05). The resistance rates to ampicillin, cefazolin, and cefuroxime were all higher than those in the control group (all> 40.0% , Imipenem and meropenem, respectively. The rates of ESBLs-producing ICU and non-ICU were 70.7% and 40.4%, respectively. The difference was statistically significant (P <0.05). Conclusion The Klebsiella pneumoniae isolated from ICU has a high rate of ESBLs production and the resistance rate to 18 kinds of antibiotics is obviously higher than that of non-ICU. When antibacterial drugs are used to treat the infections, the results of drug susceptibility test should be based on clinical ESBLs. To monitor the drug resistance of Klebsiella pneumoniae, understand its drug resistance trend and reduce the production of drug-resistant strains.