目的 分析濮阳市人民医院肺炎克雷伯菌(Klebsiella pneumoniae,K. pneumoniae, KPN) 的临床分布、流行病学特点及耐药情况,以促进临床合理用药。方法 回顾性分析濮阳市人民医院2020年1—3月临床送检标本中分离出的209株肺炎克雷伯菌的分布及耐药情况。结果 临床标本中共分离出肺炎克雷伯菌209株,在肠杆菌科细菌中占比为68.30%;标本来源以痰液、血液和尿液为主,分别占75.11%、9.09%、5.74%;分离菌株数量较多的科室为ICU、神经外科一病区、EICU病区和胸外科病区,分别占比47.37%、 17.7%、3.35%和3.35%。产超广谱β-内酰胺酶(ESBLs)菌株检出率为11.48%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为58.37%。不同来源KPN的耐药性具有显著差异, 综合ICU KPN的耐药率高于其他病区。结论 濮阳市人民医院临床分离KPN对常用抗菌药物有一定的耐药性,尤其以综合ICU分离菌株耐药严重,应加强监测KPN耐药情况,有针对性的选择抗菌药物,并增强院感防控,以减轻KPN的耐药情况。

Objective To analyze the characteristic of clinical distribution, epidemiological and drug resistance of Klebsiella pneumoniae (KPN) in the People's Hospital of Puyang City,and to provide evidence for rational use of antimicrobial drugs in clinical treatment. Methods A retrospectively analysis was conducted on 209 strains of KPN isolated from the clinical specimens in the People's Hospital of Puyang City from January 2020 to March 2020. Results A total of 209 strains of KPN were isolated from clinical specimens, accounting for 68.30% of enterobacteriaceae bacteria; the sources of specimen were mainly from sputum, blood and urine, accounting for 75.11%, 9.09% and 5.74% respectively; the departments with more isolated strains were ICU department, neurosurgery first department, EICU department, and thoracic surgery department, accounting for 47.37%, 17.7%, 3.35% and 3.35% respectively. Besides, the detection rate of extended spectrum β-lactamase(ESBLs) strains was 11.48%,and the detection rate of carbapenems-resistant klebsiella pneumoniae (CRKP) strains was 58.37%. The results showed that the drug resistance of KPN from different sources was with a significantly difference, and the drug resistance rate of KPN in comprehensive ICU was significantly higher than that of other departments. Conclusion The resistance of KPN isolated from the People's Hospital of Puyang City to common antibiotics is not optimistic. In particularly, the drug resistance of KPN isolated strains from the comprehensive ICU is more serious. Hence, the monitoring of KPN resistance should be strengthened and the effective prevention and control measures of hospital infection should be adopted. Furthermore, antibacterial drugs should be used rationally to reduce the generation of drug-resistant bacteria.

目的 探讨黄连素联合左氧氟沙星对肺炎克雷伯菌(KPn)抑菌作用。方法 KPn分为敏感株组和耐药株组,采用琼脂二倍稀释法测定黄连素联合左氧氟沙星对KPn的最低抑菌浓度(MIC)、抑制99％接种细菌生长的最低抑菌浓度(MIC99)、防突变浓度(MPC);比浊法测定黄连素联合左氧氟沙星对KPn生长曲线的影响。结果 与单用左氧氟沙星相比,联合黄连素后,敏感株组和耐药株组对左氧氟沙星MIC的下降率分别为33.3%和20%,2组之间无统计学差异(P>0.05)。左氧氟沙星与50 μg/mL黄连素或500 μg/mL黄连素联用后的抗菌能力均较单用左氧氟沙星好,且高浓度黄连素的联合抑菌效果较低浓度更加明显,差异有统计学意义(P<0.05)。与50 μg/mL黄连素联用后,左氧氟沙星SI下降了1/5 ;而与500 μg/mL黄连素联用则下降3/5 。结论 本实验证明了黄连素与左氧氟沙星联用能增加左氧氟沙星对KPn的抗菌作用,可以明显缩小耐药突变选择窗(MSW),且高浓度黄连素联合抗菌作用较低浓度好。

Objective To explore antibacterial effect of berberine(Ber) on K. Pneunmoniae(KPn) combing with levofloxacin(LVX). Methods KPn was divided into sensitive and resistant strains groups.The MIC, MIC99 and MPC of Ber combing with LVX on KPn was determined by the agar dilution method.The growth curve of Ber combing with LVX on KPn was measured by turbidimetry. Results Ber combined with LVX compare with LVX alone, MIC descent rate of sensitive strains group was 33.3%, resistant strains group was 20%, and there were no statistical differences along two groups(P>0.05). Ber combined with LVX could increase antibacterial effect and high concentration was more obvious than the low one, there were statistical differences(P<0.05). Compared with LVX alone,the SI value of 50 μg/mL Ber combined with LVX was decreased 1/5, and the SI value of 500 μg/mL Ber combined with LVX was decreased 3/5. Conclusion Ber combing with LVX could increase bacteriostatic effect on KPn,and reduce MSW significantly; high concentration of berberine was better than low one.

目的 确定CD4⁺CD25⁺Treg调节性T细胞在重症肺炎克雷伯菌肺炎中的表达以及意义,探讨CD4⁺CD25⁺Treg在重症肺炎克雷伯菌肺炎的免疫抑制中的调控作用。方法 通过气管内滴注肺炎克雷伯菌菌液建立重症肺炎模型。采用流式细胞仪检测CD4⁺CD25⁺Treg细胞及酶联免疫吸附法(ELISA)等方法检测各种细胞因子。结果 重症肺炎克雷伯菌肺炎大鼠的脾脏和肺中CD4⁺CD25⁺Treg的数量增加。使用了CD25抗体(PC61)去除机体内源性的CD4⁺CD25⁺Treg,分别去除脾脏和肺的94%和90%的CD4⁺CD25⁺Treg。CD25抗体组在建模4 h,12 h及24 h后,肺部MPO及血清IL-1,IL-6,MIP-2较对照组高(P<0.05),肺和BLA比对照组高(P<0.05),CD25抗体组大鼠生存率比对照组低(P<0.05)。结论 内源的CD4⁺CD25⁺Treg对大鼠抑制重症肺炎克雷伯菌肺炎的过度免疫损害反应起到保护作用。

Objective To confirm the expression and meaning of the T regular cell in the severe Klebsiella pneumonia, and to evaluate the regular and control affect in the immunologic suppression of the severe Klebsiella pneumonia. Methods To build the severe pneumonia model by intratracheally inoculated with Klebsiella pneumoniae bacteria. To check sorts of inflammation factors by the methods of ELISA and flow cytometry. Results The quantity of the CD4⁺CD25⁺Treg in the splenic and lungs of the mice with severe Klebsiella pneumonia were increased. Anti-CD25Ab(PC61) was used to remove endogenousCD4⁺CD25⁺Treg. Anti-CD25 treatment remove 90% of CD4⁺CD25⁺Treg cells. The cytokine production(IL-1β,IL-6,MIP-2)in the anti-CD25-treated group were significantly increased. And it also increased significantly in the airway neutrophil infiltration, while the survival rate had been decreased. Conclusion Endogenous CD4⁺CD25⁺Treg can provide obvious protection effect to the restraining the over immunity damage of the severe Klebsiella pneumonia for the mice.