目的 了解不同病区肺炎克雷伯菌引起血流感染的临床特征、药物敏感性和产碳青霉烯酶的耐药基因型,为临床的预防与治疗提供依据.方法 收集某院2014年1月—2016年12月内科病区、外科病区、重症监护病区和老年病区间由肺炎克雷伯菌引起血流感染患者的临床资料和感染菌株,应用Whonet 5.6进行耐药性分析;PCR法检测产碳青霉烯酶肺炎克雷伯菌(CRKP)的耐药基因,并采用多点位序列分型(MLST)进行分子遗传学分析.结果 共纳入血流感染患者135例,以院内感染为主,男性患者居多.基础疾病以消化系统疾病为主,以合并肺部感染最常见,分别为31.11％和21.48％,不同病区间在性别分布和感染类型上有显著意义(P＜0.05).内科病区分离的肺炎克雷伯菌对11种药物敏感率普遍高于其他病区,除复方磺胺甲噁唑(P＞0.05)外,其余10种药物(头孢曲松、头孢吡肟、头孢哌酮/舒巴坦、哌拉西林/三唑巴坦、头孢他啶、亚胺培南、美罗培南、阿米卡星、环丙沙星和左氧氟沙星)敏感性在不同病区间有显著差异(p＜0.05).共检出CRKP 28例,其中重症监护病区25例(89.29％),外科病区2例(7.14％),内科病区1例(3.57％);MLST结果显示,重症监护病区ST11型24株(96％)、ST1855型1株(4％),外科病区2株为ST 11型,内科病区1株为ST1224型;所有菌株均检测出blaKC-2和外膜蛋白ompk35基因,外膜蛋白ompk36基因占96.43％.结论 不同病区间由肺炎克雷伯菌引起的血流感染在临床特征、体外药物敏感性和碳青霉烯类耐药的基因型存在不同,预防和治疗该类患者时应根据不同病区的特点区别对待.%Objective To estimate the epidemiologic characteristics,including drug sensitivity and resistance genotypes of Klebsiella pneumoniae from different wards in a hospital.Methods The clinical data and isolated strains were collected from objects with bloodstream infections caused by Klebsiella pneumoniae in a hospital from January 2014 to December 2016,including internal departments,the surgical ward,the intensive care unit,and the elderly disease ward.The data analysis of drug resistance was curried out via the softeware Whonet (5.6).The carbapenem resistant Klebsiella pneumoniae (CRKP) gene was detected by polymerase chain reaction (PCR),and the molecular genetic analysis was carried out by MLST.Results A total of 135 patients with bloodstream infections were included,which were mainly male and patients with nosocomial infections.Among them,31.11％ and 21.48％ have digestive system and combining with pulmonary infections,respectively.There were significant differences among different wards on the gender distributions and infection types (P＜0.05).Klebsiella pneumoniae from internal departments were more sensitive to drugs (ceftriaxone,cefepime,cefoperazole,ketamine/sulbactam,piperacillin/ tazobactam,ceftazidime,imipenem,meropenem,amikacin,ciprofloxacin and levofloxacin but not trimethoprim/ sulfamethoxazole) than those from other departments.Conclusion Drugs resistance data of Klebsiella pneumoniae in different wards and basic diseases are different,and the prevention and treatment of such patients should be based on their conditions.
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