目的 探究肺炎克雷伯菌在医院中的分布状况及耐药性,并且分析生物膜阳性肺炎克雷伯菌的基因型,为临床合理用药提供依据.方法 选择本院2013年8月~2015年8月临床送检的感染性标本进行培养分离,检出160株肺炎克雷伯菌,分析该菌在医院的分布情况、耐药性及其基因型.结果 所有肺炎克雷伯菌标本中呼吸道标本及尿液标本所占比重最大,分别占59.38%和22.88%;重症监护病房检出数所占比重最高(40.63%),其次为呼吸内科的16.25%及神经内科的14.38%.肺炎克雷伯菌对氨苄西林的耐药率占首位,为80.00%;其次为头孢唑啉(67.50%);第三为头孢曲松(65.00%).氨苄西林/舒巴坦、复方新诺明和头孢噻肟(三代)的耐药率在50%以上.耐药率最低者为厄他培南,其次为亚胺培南.所有160株肺炎克雷伯菌中生物膜阳性比例为37.50%.检出ESBLs的16株生物膜肺炎克雷伯菌中,扩增出TEM基因和SHV基因所占比例分别为41.75%和31.25%,同时存在SHV及TEM基因所占比例为12.50%,但均未检测出CTX2M.结论 重症监护病房发生肺炎克雷伯菌感染的比重较高,细菌耐药性相对较低,而SHV及TEM为产生生物膜肺炎克雷伯菌的主要基因分型.%Objective To study the distribution and drug resistance ofKlebsiellapneumoniae in hospital and analyze the genotypes of K.pneumoniaewith biofilm.Methods One hundred and sixty strains of clinical specimens were collectedfrom August 2013 to August 2015.The bacterial distribution,drug resistance and K.pneumoniae genotype were analyzed.Results K.pneumoniaedominated in the specimensfrom respiratory tract and urethra,accounting for 59.38% and 22.88%,respectively.The highest rate of ICSI was 40.63%,followed by 16.25% and 14.38%.K.pneumoniaeresistance to ampicillin accounted for 80.00%,followed by cefazolin(67.50%),and ceftriaxone,(65.00%).More than 50% of the strains tested showed relatively resistant to ampicillin/sulbactam,sulfamethoxazole and cefotaxime.Antibiotics to which K.pneumoniaeproduced less resistance included erpicane,followed by imipenem and cefotetan.The biofilm positive rate in all 160 strains was 37.50%.The ESBLs detected 16 strains of K.pneumoniae biofilm,41.75% of the bacteria presented positive TEM gene and 31.25%,SHV gene while bacteria carrying both SHV and TEM genes accounted for 12.50%.No CTX2Mwas detected.Conclusion The incidence of K.pneumoniae infection in intensive care unit is relatively high,and the drug resistance of the bacteria seems to be low.The predominant genotypes of K.pneumonia with biofilm include SHVand TEM.
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