老年与中青年患者产超广谱β-内酰胺酶肺炎克雷伯菌的分布及耐药性对比分析

摘要

目的 探讨老年与中青年患者产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的分布及耐药性,为临床医生使用抗生素提供实验室依据.方法 收集2016年1月至2016年12月中国医科大学附属盛京医院住院的老年(≥60岁)和中青年(18 ～59岁)患者的各类临床感染标本为研究对象,经实验室培养后检出产ESBLs肺炎克雷伯菌的患者125例,其中老年患者60例,中青年患者65例,按照美国临床和实验室标准协会推荐的方法对ESBLs进行初步筛选和表型确证试验,对产ESBLs的肺炎克雷伯菌进行耐药性分析,并对2组患者结果进行比较.结果 老年患者和中青年患者产ESBLs肺炎克雷伯菌的标本均主要来源于尿液、痰液、全血,分别为36.67％ (22/60)、33.33％ (20/60)、11.67％(7/60)和24.62％(16/65)、24.62％(16/65)和15.38％(10/65);老年患者与中青年患者产ESBLs肺炎克雷伯菌在分泌物标本中的分布差异有统计学意义(P＜0.05),在尿液、痰液、全血、胆汁、脓汁、引流液、脑脊液、腹水、导管中的分布差异均无统计学意义(P＞0.05).产ESBLs肺炎克雷伯菌的老年患者主要分布在呼吸科和泌尿外科,分别为20.00％(12/60)和18.33％ (11/60);而中青年患者主要分布在重症监护病房和神经外科,均为16.92％(11/65);老年患者与中青年患者产ESBLs肺炎克雷伯菌在呼吸科和妇产科的分布差异均有统计学意义(P＜0.05),在泌尿外科、普通外科、重症监护病房、神经外科、风湿免疫科、介入病房、肿瘤病房、消化科、感染科、肾脏内科、骨科、康复科、血液科、神经内科及其他科室的分布差异均无统计学意义(P＞0.05).老年与中青年患者产ESBLs肺炎克雷伯菌对大多数β-内酰胺类抗菌药物的耐药率在90.00％以上,对碳青霉烯类抗菌药物敏感;除头孢他啶和庆大霉素外,老年患者与中青年患者产ESBLs肺炎克雷伯菌的耐药率比较差异均无统计学意义(P＞0.05).结论 老年和中青年患者均可感染产ESBLs肺炎克雷伯菌;除呼吸科和妇产科外,产ESBLs肺炎克雷伯菌在临床各科室的分布差异不大.碳青霉烯类抗生素是目前治疗产ESBLs肺炎克雷伯菌最为有效的一类药物;老年患者与中青年患者产ESBLs肺炎克雷伯菌对常用抗菌药物的耐药率无明显差异;临床医师应根据药敏试验结果合理应用抗生素.%Objective To explore the distribution and drug resistance of extended-spectrum beta-lactamase (ESBLs)producing Klebsiella pneumoniae in elderly and young and middle-aged patients,and provide reference for rational use of antibiotics for clinicians.Methods Specimens of elderly (≥ 60 years old) and young and middle-aged (18-59 years old) patients who with various clinical infection in Shengjing Hospital of China Medical University from January 2016 to December 2016 were collected as the research object.ESBLs-producing Klebsiella pneumoniae was isolated from 125 patients (60 elderly patients and 65 young and middle-aged patients).The preliminary screening and phenotypic confirmatory test of ESBLs were carried according to the method which was recommended by American Clinical and Laboratory Standards Institute.The drug resistance of ESBLs-producing Klebsiella pneumoniae was analysed and the resuh of the two groups were compared.Results The specimens of ESBLs-producing Klebsiella pneumoniae strains of elderly patients were mainly from urine (36.67％),sputum (33.33％) and whole blood (11.67％);the specimens of young and middle-aged patients were also mainly from urine (24.62％),sputum(24.62％) and whole blood (15.38％).There was statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the specimens secretions between the elderly patients and the young and middle-aged patients(P ＜0.05).There was no statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the specimens of urine,sputum,whole blood,bile,pus,drain,cerebrospinal fluid,ascitic fluid and catheter between the elderly patients and the young and middle-aged patients (P ＞ 0.05).ESBLs-producing Klebsiella pneumoniae strains of elderly patients were mainly isolated from department of respiration (20.00％,12/60) and department of urinary surgery (18.33％,11/60);the ESBLs-producing Klebsiella pneumoniae strains of young and middle-aged patients were mainly isolated from department of intensive care (16.92％,11/65) and department of neurosurgery (16.92％,11/65).There was statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the department of respiration and obstetrics and gynecology between elderly patients and young and middle-aged patients(P ＜ 0.05);there was no statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the department of urinary surgery,general surgery,intensive care,neurosurgery,rheumatoid immunology,invasive technology,oncology,digestion,infection,kidney,orthopaedics,rehabilitation,hematology,neurology and other department between elderly patients and young and middle-aged patients(P ＞ 0.05).The drug resistance rates of ESBLs-producing Klebsiella pneumoniae to beta-lactam antibiotic in elderly and young and middle-aged patients were more than 90.00％;the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to carbapenems were nearly 0.00％ in elderly and young and middle-aged patients.There was significant difference in the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to ceftazidime and gentamicin between elderly patients and young and middle-aged patients(P ＜ 0.05);there was no significant difference in the drug resistance rate of ESBLs-producing Klebsiella pneumoniae to another antibiotic between elderly patients and young and middle-aged patients (P ＞ 0.05).Conclusion Both elderly and the young and middle-aged patients can be infected with ESBLs-producing Klebsiella pneumoniae.There was no significant difference in the distribution of ESBLs-producing Klebsiella pneumoniae in most clinical departments (except respiratory and obstetrics and gynecology).The most effective antimicrobial drugs at present for the treatment of ESBLs-producing Klebsiella pneumoniae was carbapenems.There is no significant difference in the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to common antibiotics between elderly patients and young and middle-aged patients.Clinicians should rationally use antibiotics according to the results of susceptibility tests.