肺炎克雷伯菌在老年痴呆合并感染患者中的分布及耐药性研究

来源:用户上传      作者:林秀琴　凌迎春　梁美春　方益荣

　　[摘要] 目的 研究肺炎克雷伯菌在老年V呆合并感染患者中的分布及耐药性。方法 收集2019年1―12月浙江省绍兴市第七人民医院住院的老年痴呆合并感染患者167例，患者标本接种到血平板35℃培养24～48 h，分离到非重复的肺炎克雷伯菌167株，置于菌株保存管中-80℃保存。将-80℃保存的菌株复苏后转至血平板培养单个菌落后，采用Vitek 2 Compact对分离菌株进行鉴定及药敏试验。经统计分析后，研究肺炎克雷伯菌在老年痴呆合并感染患者中的分布及耐药性。结果 ①在老年痴呆合并感染患者中不同样本来源和不同患者性别的ESBL阴性/阳性差异均无统计学意义。除厄他培南和替加环素外，其他14种抗菌药物的耐药率男性都高于女性。②就性别差异而言，女性患者ESBL阳性的肺炎克雷伯菌对头孢吡肟、庆大霉素、妥布霉素、环丙沙星、左旋氧氟沙星的耐药率明显高于男性;而对哌拉西林/他唑巴坦、头孢唑林、头孢吡肟、头孢西丁、氨曲南、环丙沙星、复方新诺明的耐药率男性明显高于女性，显示性别差异有统计学意义（P<0.05）。③ESBL阳性的肺炎克雷伯菌对头孢吡肟、厄他培南、庆大霉素、妥布霉素、呋喃妥因、替加环素的耐药率在不同样品来源中，差异均有统计学意义（P<0.05）。除哌拉西林/他唑巴坦、亚胺培南（P>0.05）外，其他14种抗菌药物在ESBL阳性和阴性的肺炎克雷伯菌间差异均有统计学意义（P<0.05）。结论 对老年痴呆合并感染患者中检出的肺炎克雷伯菌，要根据患者的性别、菌株是否产超广谱β-内酰胺酶以及标本来源不同选择不同的抗菌药物。
　　[关键词] 肺炎克雷伯菌;老年痴呆;感染;耐药率
　　[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701（2022）09-0131-06
　　Distribution and drug resistance of Klebsiella pneumoniae in senile dementia patients complicated with infection
　　LIN Xiuqin1 LING Yingchun1 LIANG Meichun2 FANG Yirong3
　　1.Clinical Laboratory， No.7 People′s Hospital of Shaoxing City in Zhejiang Province， Shaoxing 312000， China; 2.Clinical Laboratory， Shaoxing People′s Hospital in Zhejiang Province， Shaoxing 312000， China; 3.Shaoxing Center for Disease Control and Prevention in Zhejiang Province， Shaoxing 312000， China
　　[Abstract] Objective To study the distribution and drug resistance of Klebsiella pneumoniae in senile dementia patients complicated with infection. Methods A total of 167 inpatients with senile dementia complicated with infection in No.7 People′s Hospital of Shaoxing City in Zhejiang Province from January to December 2019 were collected. The specimens of the patients were inoculated on blood plate and cultured at 35℃ for 24 to 48 hours. 167 non-repetitive Klebsiella pneumoniae strains were isolated and stored in strain preservation tube at -80℃. The strains stored at -80℃ were resuscitated， and then transferred to blood plate to culture single colonies. Vitek 2 Compact was used to identify the isolated strains and their drug sensitivity was tested. After statistical analyses， the distribution and drug resistance of Klebsiella pneumoniae in senile dementia patients complicated with infection were studied. Results ①There was no significant difference in the negative/positive ESBL between different sample sources and different patients′ gender. Except ertapenem and tigecycline， the drug resistance rates of other 14 antibiotics were higher in male than in female. ②In terms of gender differences， the resistance rate of ESBL-positive Klebsiella pneumoniae to cefepime， gentamicin， tobramycin， ciprofloxacin and levofloxacin in female patients was significantly higher than that in male patients. However， the drug resistance rates of ESBL-positive Klebsiella pneumoniae to piperacillin/tazobactam， cefazolin， cefepime， cefoxitin， aztreonam， ciprofloxacin and sulfamethoxazole in male were significantly higher than those in female （P<0.05）， showing that there was a significant gender difference. ③There were statistically significant differences in the resistance rates of ESBL-positive Klebsiella pneumoniae to cefepime， ertapenem， gentamicin， tobramycin， nitrofurantoin and tigecycline in different sample sources （P<0.05）. Except piperacillin/tazobactam and imipenem （P>0.05）， the other 14 antimicrobial agents （P<0.05） showed statistically significant difference between ESBL-positive and ESBL-negative Klebsiella pneumoniae. Conclusion For Klebsiella pneumoniae detected in patients with senile dementia complicated with infection， different antibiotics should be selected according to the gender of the patients， whether the strains produce extended-spectrum β-lactamases and different sample sources.

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