张爱荣

[摘要] 目的 了解河南省商丘市第一人民医院（以下简称“我院”）碳青霉烯类耐药肺炎克雷伯菌（CRKP）临床分布特点及其对临床常用抗菌药物的敏感性。 方法 收集我院2014年1月～2017年7月临床分离的CRKP，分析其对常用抗菌药物的敏感性，纸片扩散法检测其碳青霉烯酶和金属酶。 结果 共收集CRKP 156株，科室分布和标本种类分别以重症监护病房（73.7%，115/156）和呼吸道标本（76.3%，119/156）为主。药敏试验结果显示，对多黏菌素、替加环素、米诺环素、四环素敏感率分别为100.0%、92.8%、88.5%，64.1%；对甲氧苄啶/磺胺甲噁唑、氯霉素、阿米卡星和左氧氟沙星的敏感率分别为39.7%、30.1%、29.5%和23.1%；对β内酰胺类、头孢菌素类及其复合制剂均高度耐药。78.2% CRKP产生碳青霉烯酶（122/156），分离4株金属酶阳性菌株。 结论 重症监护病房、神经科、老年医学科患者呼吸道感染是CRKP防控重点。碳青霉烯酶是本地CRKP耐碳青霉烯类抗菌药物的主要方式；CRKP对多粘菌素与四环素类之外的抗菌药物严重耐药；在我院多黏菌素、替加环素、米诺环素可作为CRKP临床感染救治的备选药物。

[关键词] 耐碳青霉烯类肺炎克雷伯菌；临床分布；敏感性；耐药机制；碳青霉烯酶；金属酶

[中图分类号] R378.99 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0178-04

[Abstract] Objective To investigate the distribution and susceptibility of carbapenem-resistant Klebsiella pneumoniae （CRKP） isolated from the First People′s Hospital of Shangqiu. Methods CRKP was collected from January 2014 to July 2017 and the results were analyzed， producing of carbapenemase and metallo-beta-lactamases were confirmed using Kirby-Bauer method. Results A total of 156 CRKP were collected and mainly from ICU （73.7%，115/156） and respiratory specimens （76.3%，119/156）. The results of antimicrobial susceptibility testing showed that the sensitivity of polymyxin， tigecyline， minocycline and tetracycline were 100.0%， 92.8%， 88.5% and 64.1% respectively. The sensitive rates of methoxybenzidine-sulfamethoxazole， chloramphenicol amikacin， and levofloxacin were 39.7%， 30.1%， 29.5% and 23.1% respectively. It was serious resistant to beta-lactam， cephalosporin and its compound preparations. 78.2% CRKP produced carbapenemase （122/156） and 4 strains of metalloenzyme were isolated. Conclusion The patients from the ICU， neurology and geriatrics ward with respiratory tract infection should be importance of strengthen infection control in our hospital. To produce carbapenemase is the main method of local CRKP resistances. The situation of antibiotic resistance of CRKP is very serious except polymyxin and tetracycline species， so polymyxin， tigecyline and minocycline can be used in clinical practice of CRKP infection.

[Key words] Carbapenem-resistant Klebsiella pneumoniae； Distribution； Susceptibility； Mechanism of antibiotic resistance； Carbapenemase； Metallo-beta-lactamases

肺炎克雷伯菌（Klebsiella pneumoniae，KPN）常存在于人體的呼吸道和消化道，但当人体抵抗力降低或其他原因常可引起典型的原发性肺炎、泌尿道甚至血液感染等，是临床感染最常见的病原菌之一。肺炎克雷伯菌可以通过产生β-内酰胺酶、生物被膜的形成以及外膜孔蛋白的缺失等多种机制对抗菌药物而产生耐药性。……