Objective To analyze the distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP), and to study the prognosis of patients infected with CRKP.Methods One hundred and fifteen patients with K.pneumoniae hospital infection were selected from January 2012 to December 2015 in the present study.Bacterial culture, identification and drug sensitivity test were carried out;then these 115 patients were divided into the CRKP group (53 cases) and non-CRKP group (62 cases) according to the results of drug sensitivity test, and prognosis of them were observed and analyzed.Results ①One hundred and sixty-four strains of K.pneumoniae were isolated from the 115 patients, and they were distributed in different specimens such as 48 strains (29.3%) in the sputum, 37 strains (22.6%) in the blood, 26 strains (15.9%) in the drainage liquid, 22 strains (13.4%) in the Pus, 15 strains (9.1%) in the bile, 9 strains (5.5%) in the urine and 7 strains (4.3%) in the wound secretion.②K.Pneumoniae isolated from 53 patients were identified as the CRKP (75 strains), and that isolated from the other 62 patients were identified as the non-CRKP (89 strains).The resistance rate of K.Pneumoniae: it was more than 95% to ampicillin, amoxicillin/clavulanate, cefalotin, cefotaxime, aztreonam, meropenem, gentamicin and ciprofloxacin.But that was less than 50% to tetracycline, tigecycline, minocycline, sulfamethoxazole and trimethoprim, fosfomycin.The resistance rate of K.Pneumoniae to piperacillin/tazobactam, imipenem and ertapenem were in 80%~90%.③Compared with the non-CRKP group, the hospitalization days after infection[(64±22) days], hospital mortality (23%) and infection related mortality (32%) of patients in the CRKP group were obviously higher (P<0.05), but the total effective rate (55%) were significantly lower (P<0.05).ConclusionK.pneumoniae are widely distributed in sputum of patients with infection, and CRKP has a high drug resistance to most antibiotics that used in clinical practice commonly.So patients infected with CRKP suffered a poor prognosis but a high fatality rate.%目的 分析耐碳青酶烯类肺炎克雷伯菌(CRKP)的分布特征及耐药性,了解CRKP感染患者的预后情况.方法 对2013年1月至2015年12月在本院住院治疗期间发生肺炎克雷伯菌感染的115例患者进行细菌培养、鉴定及药物敏感性试验;根据药敏试验结果将115例患者分为CRKP组(53例)和非CRKP组(62例),分析2组患者的预后情况.结果 ①115例患者共检出肺炎克雷伯菌164株,痰液中48株(29.3%),血液中37株(22.6%),引流液中26株(15.9%),脓液中22株(13.4%),胆汁中15株(9.1%),尿液中9株(5.5%)及创口分泌物中7株(4.3%).②115例患者中有53例分离培养得到的菌株为CRKP(75株),62例为非CRKP(89株);CRKP对氨苄西林、阿莫西林/克拉维酸、头孢噻吩、头孢噻肟、氨曲南、美罗培南、庆大霉素及环丙沙星的耐药率均高达95%以上,对哌拉西林/他唑巴坦、亚胺培南及厄他培南的耐药率达80%~90%,对四环素、替加环素、米诺环素、复方磺胺甲口恶唑及磷霉素的耐药率均在50%以下.③CRKP组患者感染后住院天数(64±22)d、院内病死率(23%)及感染相关病死率(32%)均明显高于非CRKP组(P<0.05),而临床总有效率(55%)明显低于非CRKP组(P<0.05).结论 肺炎克雷伯菌在感染患者的痰液中分布最广泛,CRKP对多数临床常用抗菌药呈高度耐药,感染CRKP的患者预后差,病死率更高.
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