[摘要] 目的 比較醫(yī)院感染和社區(qū)感染肺炎克雷伯菌的耐藥性差異，為指導臨床合理用藥提供依據(jù)。 方法 收集2015年1月～2016年12月住院患者不同標本的肺炎克雷伯菌共1393株，進行耐藥性監(jiān)測，并判斷是否為醫(yī)院感染，同時分析社區(qū)感染與醫(yī)院感染的耐藥性差異。結果 1393株肺炎克雷伯菌中，共檢出產ESBLs肺炎克雷伯菌176株，檢出率為12.63%，產ESBLs肺炎克雷伯菌對抗菌藥物的耐藥性普遍高于非產ESBLs；在肺炎克雷伯菌（ESBLs-）方面，醫(yī)院感染的菌株數(shù)對哌拉西林等四種抗菌藥的耐藥率低于社區(qū)感染，而醫(yī)院感染的肺炎克雷伯菌對頭孢他啶等五種抗菌藥的耐藥率高于社區(qū)感染；在肺炎克雷伯菌（ESBLs+）方面，醫(yī)院感染菌株對替芐西林等兩種抗菌藥的耐藥率低于社區(qū)感染，而醫(yī)院感染的菌株對復方新諾明等兩種抗菌藥的耐藥率高于社區(qū)感染，差異有統(tǒng)計學意義（P<0.05）。 結論 無論是社區(qū)感染還是醫(yī)院感染的肺炎克雷伯菌，特別是產ESBLs的肺炎克雷伯菌，對多種抗菌藥物的具有高耐藥率，醫(yī)院應加強其所致醫(yī)院感染的監(jiān)測，并積極采取有效的控制措施。
　　[關鍵詞] 肺炎克雷伯菌；醫(yī)院感染；社區(qū)感染；耐藥性
　　[中圖分類號] R446.5 [文獻標識碼] B [文章編號] 1673-9701（2018）08-0122-03
　　Investigation on drug resistance of community-acquired and hospital-acquired infections caused by Klebsiella pneumoniae
　　XIONG Kai SHI Yu
　　Medical record statistical division， The Second Clinical Medical School of Inner Mongolia University for the Nationalities，Inner Mongolia Forestry General Hospital，Yakeshi 022150， China
　　[Abstract] Objective To compare the drug resistance of Klebsiella pneumoniae between hospital-required infection and community-acquired infection， in order to provide basis for clinical rational drug use. Methods A total of 1393 strains of Klebsiella pneumoniae were collected from different samples of patients who were hospitalized from January 2015 to December 2016， in order to monitor the drug resistance and determine whether they were hospital-acquired infections. The differences in drug resistance between community and hospital acquired infections were analyzed. Results Among 1393 strains of Klebsiella pneumoniae， 176 strains of Klebsiella pneumoniae producing ESBLs were detected， the detection rate was 12.63%. The ESBLs-producing Klebsiella pneumoniae strains were generally more resistant to antibiotics than non-ESBLs-producing strains. In the case of Klebsiella pneumoniae（ESBLs-）， the drug resistance rates of hospital-acquired infections to four antibacterials， such as piperacillin， were lower than that of community-acquired infections， whereas the drug resistance rates of hospital-acquired Klebsiella pneumoniae to five antibacterial drugs including ceftazidime were higher than that of community-acquired infection. In the case of Klebsiella pneumoniae （ESBLs+）， the drug resistance rates of hospital-acquired infections to two antibacterials such as ticarcillin were lower than that of community-based ones， while the resistance rates to two antibacterials including cotrimoxazole were higher than that of community infection（P<0.05）. Conclusion lebsiella pneumoniae， especially ESBLs-producing Klebsiella pneumoniae， both community-acquired and hospital-acquired， have a high rate of drug resistance to a wide range of antibacterial agents. The hospital-acquired infections should be monitored and treated actively through effective control measures.

相關熱詞搜索：感染 耐藥 肺炎 克雷 醫(yī)院