CAJ | 학술논문

目的：了解耐碳青霉烯类抗生素肺炎克雷伯菌（ CRKP）的临床分布及耐药特性。方法收集临床标本分离的54株及呼吸机分离的13株碳青霉烯类（亚胺培南或美罗培南）耐药CRKP，用纸片扩散法检测其对临床常用抗菌药物的敏感度，E－test法测替加环素MIC值；采用双纸片增效试验检测ESBLs。结果54株CRKP临床分离株以痰液（ n＝39）为主，其次为血液和尿液（均为n＝4）。 CRKP科室分布主要来自于ICU（44．44％）、消化内科（22．22％）、呼吸内科（9．26％）。 CRKP对临床常用的18种抗菌药物中有9种耐药率＞90％，主要是青霉素类和头孢菌素类，其中对哌拉西林、头孢曲松和头孢他啶耐药率为100％；耐药率最低的为替加环素（4．48％），其次为多黏菌素B（23．88％）及四环素（26．87％）。呼吸机分离株与临床分离株耐药谱较一致（P＞0．05）。67株分离株中ESBLs（＋）为28株（41．79％）。结论 CRKP临床分布广泛，主要集中在ICU；CRKP耐药及多重耐药性严重，临床可选用的抗菌药物非常有限，替加环素对CRKP具有较强的体外抗菌活性。
목적：료해내탄청매희류항생소폐염극뢰백균（ CRKP）적림상분포급내약특성。방법수집림상표본분리적54주급호흡궤분리적13주탄청매희류（아알배남혹미라배남）내약CRKP，용지편확산법검측기대림상상용항균약물적민감도，E－test법측체가배소MIC치；채용쌍지편증효시험검측ESBLs。결과54주CRKP림상분리주이담액（ n＝39）위주，기차위혈액화뇨액（균위n＝4）。 CRKP과실분포주요래자우ICU（44．44％）、소화내과（22．22％）、호흡내과（9．26％）。 CRKP대림상상용적18충항균약물중유9충내약솔＞90％，주요시청매소류화두포균소류，기중대고랍서림、두포곡송화두포타정내약솔위100％；내약솔최저적위체가배소（4．48％），기차위다점균소B（23．88％）급사배소（26．87％）。호흡궤분리주여림상분리주내약보교일치（P＞0．05）。67주분리주중ESBLs（＋）위28주（41．79％）。결론 CRKP림상분포엄범，주요집중재ICU；CRKP내약급다중내약성엄중，림상가선용적항균약물비상유한，체가배소대CRKP구유교강적체외항균활성。
Objective To evaluate the susceptibility of carbapenems-resistant Klebsiella pneumoniae ( CRKP ) to antimicrobial agents, and to explore the distribution of clinical isolates of CRKP.Methods Fifty-four strains from different clinical specimens and 13 strains from ventilator CRKP were collected. Susceptibility to commonly used antimicrobial agents were detected by disc diffusion, the MICs of tigecycline were determined using E-test strip.Double disk synergy test was employed to examine ESBLs.Results Of the 54 clinical isolates, sputum was the most common source of CRKP ( n =39 ) , then blood and urine ( n =4 ) .The most common clinical department was the Intensive Care Units (ICU, 44.44%), then Digestive System Department (22.22%), respiratory department (9.26%) .According to the antimicrobial susceptibility test, all the isolates showed the high resistance rate to multiple antibiotics over 90%, of which, the resistance rates of ceftazdime, ceftriaxone, piperacillin up to 100%.The lowest resistance rates were tigecycline (4.48%), polymyxin B (23.88%), tetracycline (26.87%).The ventilator isolates showed a antibiogram parallel to clinical isolates with no statistical difference.Of the 67 isolates, 28 ( 41.79%) strains producing ESBLs. Conclusion CRKPs are widespread in clinical and mainly in ICU.The resistant rate and multi-drug resistant of CRKP is tremendous.The treatment of clinical infections due to multiresistant CRKP remains a challenge.Tigecycline has effective antimicrobial activity against CRKP.