CAJ | 학술논문

目的：调查分析临床产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药性，为临床合理使用抗菌药物和及早预防和控制医院感染提供科学依据。方法回顾性统计2012年1月~2013年12月嘉兴地区两所综合性三甲医院中分离的产ESBLs肺炎克雷伯菌的临床资料，进行耐药性分析。结果2012年1月~2013年12月间共检出肺炎克雷伯菌4145株，其中产ESBLs菌株855株，且2012、2013年阳性检出率分别为19.95%(387/1940)、21.22%(468/2205)；菌株来源主要为呼吸道标本和尿液标本；2012、2013年亚胺培南、美洛培南和厄他培南对产ESBLs肺炎克雷伯菌的耐药率分别为11.17%、4.55%，6.01%、5.38%和9.34%、8.23%；头孢哌酮/舒巴坦、阿米卡星和替加环素对产ESBLs肺炎克雷伯菌的耐药率分别为10.42%、12.65%，4.39%、6.62%和8.70%、11.01%。结论产ESBLs肺炎克雷伯菌比非产ESBLs菌株具有更高的耐药率，药物治疗可以选择亚胺培南、美洛培南、厄他培南、头孢哌酮/舒巴坦、阿米卡星和替加环素。
목적：조사분석림상산초엄보β-내선알매(ESBLs)폐염극뢰백균적내약성，위림상합리사용항균약물화급조예방화공제의원감염제공과학의거。방법회고성통계2012년1월~2013년12월가흥지구량소종합성삼갑의원중분리적산ESBLs폐염극뢰백균적림상자료，진행내약성분석。결과2012년1월~2013년12월간공검출폐염극뢰백균4145주，기중산ESBLs균주855주，차2012、2013년양성검출솔분별위19.95%(387/1940)、21.22%(468/2205)；균주래원주요위호흡도표본화뇨액표본；2012、2013년아알배남、미락배남화액타배남대산ESBLs폐염극뢰백균적내약솔분별위11.17%、4.55%，6.01%、5.38%화9.34%、8.23%；두포고동/서파탄、아미잡성화체가배소대산ESBLs폐염극뢰백균적내약솔분별위10.42%、12.65%，4.39%、6.62%화8.70%、11.01%。결론산ESBLs폐염극뢰백균비비산ESBLs균주구유경고적내약솔，약물치료가이선택아알배남、미락배남、액타배남、두포고동/서파탄、아미잡성화체가배소。
Objective To investigate the drug resistance status of extended-spectrumβ-lactamases (ESBLs)-producing Klebsiella pneumoniae, so as to provide scientific evidence for reasonable use of antibiotics in clinic and for prevention and control of nosocomial infection at an early date. Methods The clinical isolated ESBLs-producing Klebsiella pneu-moniae date was collected from two grade A comprehensive hospitals from January 2012 to December 2013 in Jiaxing, and then the drug resistance of ESBLs-producing Klebsiella pneumoniae was analyzed. Results A total of 4145 strains of Klebsiella pneumoniae were isolated in two years of January 2012 and December 2013, including ESBLs-producing Klebsiella pneumoniae 855 strains, with the isolation rate of 19.95% (387/1940) and 21.22% (468/2205) in 2012 and 2013 separately. The majority of strains were isolated from the respiratory tract specimens and the urine specimens. In 2012, 2013 year, the drug resistance rate of the ESBLs-producing Klebsiella pneumoniae to Imipenem was 11.17%, 4.55%, Meropenem was 6.01%, 5.38% and Ertapenem was 9.34%, 8.23%; the drug resistance rate of the ESBLs-pro-ducing Klebsiella pneumoniae to Cefoperazone-Sulbactam was 10.42%, 12.65%, Amikacin was 4.39%, 6.62% and Tigecycline was 8.70%, 11.01%. Conclusion The drug resistance rate of the ESBLs-producing Klebsiella pneumoniae is signficantly higher than that of the non-ESBLs-producing strains; the Imipenem, Meropenem, Ertapenem, Cefopera-zone-Sulbactam, Amikacin and Tigecycline are recommended for the therapy of ESBLs-producing Klebsiella pneumoni-ae infection.