目的：了解2013年河北省细菌耐药性监测网(Hebarin)三级甲等医院临床分离肺炎克雷伯菌的耐药情况。方法收集河北省耐药监测网2013年上报数据合格单位分离自各类临床标本的肺炎克雷伯菌,统一采用纸片扩散法(K-B 法)或肉汤稀释法进行药敏实验,按照 CLSI(2012年版)判定标准进行结果判读。结果2013年河北省细菌耐药监测网成员单位上传的数据中,肺炎克雷伯菌占5037株,其中1515株肺炎克雷伯菌进行了产超广谱β内酰胺酶(ESBLs)确证试验,有570株产 ESBLs,检出率为37.6%。肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率最低,耐药率均在4%以下；对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率分别为4.6%和5.0%；但对第二代、第三代头孢菌素的耐药率除头孢他啶(24.6%)、头孢吡肟(22.4%)、头孢西丁(20.5%)外均在40%以上,对氨基糖苷类药物的耐药率为9.0%~34.3%,对氟喹诺酮类药物耐药率为13.4%~19.5%,对复方新诺明耐药率为42.0%。结论肺炎克雷伯菌对临床常用抗菌药物耐药率较高,应加强抗菌药物的合理使用及院内感染的控制。%Objective Understanding of bacterial drug resistance monitoring network in Hebei province in 2013 through different clinical specimens of klebsiella pneumoniae.Methods Drug resistance monitoring network in Hebei province 2013 was the source data of qualified units isolated from various clinical specimens pneumonia klebsiella bacteria,unified by disc diffusion method (K-B method),medicine sensitive experiment or broth dilution method according to CLSI standards (201 1 edition).Results Member of bacterial drug resistance monitoring network in Hebei province 2013 to upload data,klebsiella pneumoniae accounted for 5 037 isolates,including 1 5 1 5 strains of pneumonia klebsiella bacteria to produce ultra broad spectrum beta lactamase (ESBLs)confirmed test,570 producing ESBLs strains,the detection rate of 37.6%.klebsiella pneumoniae on carbapenem antimicrobial resistance to a minimum, percentages of all below 4%;To cefoperazone/shu ba jotham and piperacillin/he azole temple resistant rate of 4.6%and 5.0% respectively;In addition to cefotaxime (24.6%),cefepime (22.4%),cefoxitin (20.5%),the percentages of the second and third generation cephalosporin,were over 40%.Drug resistant rate of aminoglycoside was 9.0%-34.3%, the percentages of fluoroquinolone drugs was 13.4%-1 9.5%, resistant rate of Trimethoprim -sulfamethoxazole was 42.0%.Conclusion Antimicrobial resistance of Klebsiella pneumoniae was very high.We should strengthen the rational use of antimicrobial drugs and control the nosocomial infection.
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