摘要
目的分析北京市海淀医院肺炎克雷伯菌致血流感染（BSI）的临床特征及对常用抗菌药物的耐药性，为临床治疗肺炎克雷伯菌血流感染提供参考。方法收集本院2012年1月至2012年12月确诊为肺炎克雷伯菌血流感染患者的临床资料和抗菌药物耐药性进行分析，采用SPSS12．0软件进行统计学分析。结果临床分离的14株肺炎克雷伯菌感染广泛分布于全院各科室，多见于老年、恶性肿瘤、尿毒症或脑血管病等危重患者，本研究14例患者均为继发性BSI，多继发于肺部感染及肝胆系统感染。细菌耐药结果显示对青霉素及一代、二代头孢、部分氨基糖甙类、磺胺类抗菌药物等相对耐药，耐药率分别为氨苄西林（85．7％）、哌拉西林（57．1％）、头孢唑林（42．9％）、头孢氨苄／舒巴坦（57．1％）、头孢呋辛（42．9％），庆大霉素（42．9％）和复方新诺明（42．9％），耐药率均达40％以上；对三代头孢、含β-内酰胺酶抑制剂的青霉素、三代喹诺酮、单环β-内酰胺酶耐药率相对减低，分别为头孢曲松（21．4％）、头孢他啶（21．4％）、哌拉西林他唑巴坦（28．6％）、环丙沙星（28．6％）和氨曲南（21．4％），耐药率为20％430％；对四代头孢、三代喹诺酮、部分氨基糖甙类、呋喃类抗菌药物，如头孢吡肟（7．1％）、左氧氟沙星（14．3％）、阿米卡星（7．1％）、妥布霉素（15．6％）和呋喃妥因（7．1％），耐药率均在20％以下；未发现对头胞哌酮／舒巴坦和碳氢酶烯类药物耐药。结论肺炎克雷伯菌是常见的继发性BSI的致病菌之一，对部分临床经验用抗菌药物出现了不同程度的耐药，应加强针对本地区或医院的细菌性耐药性监测，指导临床经验抗感染治疗。
Objective To investigate the clinical features and drug resistance to Klebsiella pneumoniae in 14 cases of bloodstream infection （BSI） in 2012 of Beijing Haidian hospital （Haidian Section of Peking University Third Hospital） and provide a reference for the clinical treatment of Klebsiella pneumoniae. Methods Clinical data and antibiotic resistance of the patients infected with Klebsiella pneumoniae of bloodstream from January to December in 2012 were collected, retrospectively, Statistical analysis was done by SPSS 12.0. Results All the 14 clinical isolates of Klebsiella pneumoniae infection were widely distributed in various hospital departments. The infection were more common in the elderly, cancer, uremia, cerebrovascular diseases and other critical patients. All the 14 cases were secondary BSI and mostly secondary to pulmonary infection and hepatobiliary tract infection. The rate of bacterial resistance to ampicillin （85.7%）, piperacillin （57.1%）, cefazolin （42.9%）, cephalexin and sulbactam （57.1%）, cefuroxime （42.9%）, gentamicin （42.9%） and cotrimoxazole （42.9%）, were more than 40%; the rate to eeftriaxone （21.4%）, ceftazidime （21.4%）, piperacillin and tazobactam （28.6%）, ciprofloxacin （28.6%） and aztreonam （21.4%） were 20%-30%; and the rate to cefepime （7.1%）, cefotetan （7.1%）, levofloxacin （14.3%）, amikacin （7.1%）, tobramycin （15.6%） and nitrofurantoin （7.1%） were all less than 20%. No resistance to carbapenems and cefoperazone/sulbactam were found. Conclusions Klebsiella pneumoniae is one of the common pathogens of secondary BSI. The different degree of drug resistance was found to some commonly used antibiotics based on clinical experience. Bacterial resistance monitoring should be strengthened in the region or hospital and could guide anti-infection treatment in clinical experience.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2014年第4期44-46,共3页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
关键词
血流感染
肺炎克雷伯菌
耐药性
Bloodstream infections
Klebsiella pneumoniae
Drug resistance
