肺炎克雷伯菌在医院环境中的分布及耐药性分析

doi:10.3969/j.issn.1673-8640.2015.02.014

摘要/Abstract

摘要： 目的

了解江苏盐城地区三级医疗机构环境中肺炎克雷伯菌的分布和耐药性,为加强控制医院内感染和临床合理使用抗菌药物提供依据。

方法

采用法国生物梅里埃公司的VITEK-32全自动微生物仪对627例标本进行肺炎克雷伯菌鉴定。并用纸片扩散法(K-B)进行药物敏感性试验检测,采用美国临床实验室标准化协会(CLSI)推荐的标准纸片扩散法检测产超广谱β-内酰胺酶(ESBLs)。

结果

从627例标本中共检出213株肺炎克雷伯菌,检出率为33.97%。肺炎克雷伯菌在医院环境中的分布以内科病房最高为66.67%,其次为妇产科病房及治疗室分别为43.84%、43.08%;肺炎克雷伯菌对青霉素类氨苄西林和阿莫西林耐药率高达96.70%和99.73%;产ESBLs菌株占34.27%(73/213)。

结论

医院环境中肺炎克雷伯菌污染较重,耐药率高,耐药谱广。应加强医院环境消毒,加强监测,严格控制院内感染的发生与流行。

关键词: 肺炎克雷伯菌, 医院环境污染, 耐药性, 产超广谱β-内酰胺酶

Abstract: Objective

To investigate the distribution and drug resistance of Klebsiella pneumoniae in the three-tier medical institutes of Yancheng city, in order to provide the reference for the prevention of nosocomial infection and the rational use of antibiotics.

Methods

Klebsiella pneumoniae was determined by VITEK-32 automatic microorganism analyzer, which was produced by France BioMerieux Company. A total of 627 samples were used for Klebsiella pneumoniae determination. Drug sensitivity test of Klebsiella pneumoniae was performed by disk diffusion (K-B ) method. Standard disk diffusion method suggested by the Clinical and Laboratory Standards Institute (CLSI) was employed to conduct the extended-spectrum beta lactamase (ESBL) test.

Results

A total of 213 Klebsiella pneumoniae positive samples were determined from the 627 samples. The positive rate was 33.97%. The highest prevalence of Klebsiella pneumoniae positive samples was observed in the ward of Internal Medicine Department (66.67%), followed by Department of Obstetrics and Gynecology (43.84%) and Treatment Room (43.08%).The resistance rates of Klebsiella pneumoniae to ampicillin and amoxicillin were 96.70% and 99.73%, respectively. A total of 34.27% (73/213) of the determined Klebsiella pneumoniae was ESBL-produced Klebsiella pneumoniae.

Conclusions

The pollution of Klebsiella pneumoniae is common in medical environment with high resistance rate. In order to control the nosocomial infection of Klebsiella pneumoniae, hospital environment disinfection and inspection for Klebsiella pneumoniae pollution are needed to be further strengthened.

Key words: Klebsiella pneumoniae, Hospital environmental pollution, Drug resistance, Extended-spectrum beta lactamase

中图分类号:

R446.5

仇广翠, 孙明忠, 邵良荣, 金浩, 陆强. 肺炎克雷伯菌在医院环境中的分布及耐药性分析[J]. 检验医学, 2015, 30(2): 160-163.

QIU Guangcui, SUN Mingzhong, SHAO Liangrong, JIN Hao, LU Qiang. The distribution and drug resistance analysis of Klebsiella pneumoniae in hospital environment[J]. Laboratory Medicine, 2015, 30(2): 160-163.

图/表 3

参考文献 7

[1]	李悦,崔振泽,于爱民,等.医院环境监测与临床分离的肺炎克雷伯菌的同源性分析[J].中国当代儿科杂志,2011,13(12):997-998.
[2]	张海涛,杨方伦,许建屏,等.病原微生物对抗菌药物的耐药性调查[J].中华医院感染学杂志,2003,13(5):470-473.
[3]	GIAMARELLOU H.Multidrug resistance in Gram-negative bacteia that produce extended-spectrum beta-lactamases(ESBLs)[J].Clin Microbiol Infect,2005,11(Suppl 4):1-16.
[4]	李振江,孙长贵,曾贤铭,等.肺炎克雷伯菌医院感染监测及耐药性分析[J].中华医院感染学杂志,2007,17(6):737-739.
[5]	吉冬元,孟庆华,杨惠萍,等.184株肺炎克雷伯菌耐药性分析[J].临床内科杂志,2010,27(1):63-64.
[6]	BIN C, HUI W, RENYUAN Z, et al.Outcome of cephalosporin treatment of bacteremia due to CTX-M-type extended-spectrum beta-lactamase-producing Escherichia coli[J]. Diagn Microbiol Infect Dis, 2006, 56(4):351-357.
[7]	卜劲松. 201株肺炎克雷伯菌耐药性分析及其gyrA基因分析[J].中华医院感染学杂志,2012,22(1): 9-11.

年份	三级医院			二级医院			一级医院
年份	标本数	检出菌株数	检出率(%)	标本数	检出菌株数	检出率(%)	标本数	检出菌株数	检出率(%)
2011	75	19	25.33	75	21	28.00	48	20	41.67
2012	90	29	32.22	80	26	32.50	45	21	46.67
2013	89	30	33.70	85	29	34.12	40	18	45.00

年份	三级医院			二级医院			一级医院
年份	标本数	检出菌株数	检出率(%)	标本数	检出菌株数	检出率(%)	标本数	检出菌株数	检出率(%)
2011	75	19	25.33	75	21	28.00	48	20	41.67
2012	90	29	32.22	80	26	32.50	45	21	46.67
2013	89	30	33.70	85	29	34.12	40	18	45.00

科室	菌株数	检出率(%)
内科病房	54	66.67
外科病房	25	33.33
妇产科病房	32	43.84
儿科病房	17	23.29
治疗室	28	43.08
输液室	51	36.43
医务人员手	6	5.00

科室	菌株数	检出率(%)
内科病房	54	66.67
外科病房	25	33.33
妇产科病房	32	43.84
儿科病房	17	23.29
治疗室	28	43.08
输液室	51	36.43
医务人员手	6	5.00

抗菌药物	2011年 (60株)	2012年 (76株)	2013 (77株)
氨苄西林	91.30	99.40	98.33
四环素	40.36	33.87	26.67
美罗培南	1.28	3.12	0.85
头孢唑啉	62.91	59.26	63.67
头孢噻肟	52.57	58.35	56.33
头孢他定	47.23	55.65	58.31
头孢曲松	59.64	64.35	61.91
头孢哌酮-舒巴坦	5.69	11.34	9.26
环丙沙星	26.07	33.87	25.00
庆大霉素	38.22	35.48	31.67
氨苄西林-舒巴坦	52.39	47.48	53.48
阿米卡星	21.74	19.36	25.67
亚胺培南	4.53	4.21	3.49
亚胺硫霉素	0.00	1.45	0.00
复方磺胺甲口恶唑	52.17	48.39	46.67
阿莫西林	99.04	100.00	100.00
氯霉素	15.43	17.74	13.33
呋喃妥因	20.74	32.26	26.67
诺氟沙星	86.96	100.00	100.00