耐碳青霉烯类肺炎克雷伯菌医院感染流行特征分析  

Epidemiological characteristics of nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae in a hospital

作　　者：赵强[1] 郭玲[1] 叶丽艳[1] 张樱[1] 周光[1] 罗燕萍[1] 

机构地区：[1]解放军总医院微生物科,北京100853

出　　处：《中华医院感染学杂志》2016年第21期4809-4811,共3页Chinese Journal of Nosocomiology

基　　金：国家传染病重大专项基金资助项目(2013ZX10004217002002)

摘　　要：目的分析耐碳青霉烯类肺炎克雷伯菌医院流行特征,为临床治疗提供依据。方法收集2013-2015年医院各临床科室患者临床标本分离的肺炎克雷伯菌株2 941株,对肺炎克雷伯菌医院感染的流行特征进行回顾性分析。结果 2013-2015年共分离肺炎克雷伯菌株2941株,其中耐碳青霉烯类菌株358株,2013-2015年碳青霉烯耐药率分别为3.79%、14.43%、14.53%,呈逐年上升趋势;碳青霉烯耐药菌株主要来源于痰(34.08%)、组织(16.76%)、尿(14.25%)、血液(11.17%)等标本;2013年度仅在部分科室散发,2014-2015年在肝胆外科病区、外科监护室、呼吸科监护室、神经内科监护室、呼吸科病区耐碳青霉烯类肺炎克雷伯菌持续存在,在其他科室多为散发;耐碳青霉烯类肺炎克雷伯菌对除阿米卡星、庆大霉素、磺胺甲噁唑/甲氧苄啶外的大多数抗菌药物表现高度耐药性,耐药率>85%;碳青霉烯敏感的肺炎克雷伯菌对除氨苄西林外的其他抗菌药物均保持较好的敏感性,敏感率>75%。结论肺炎克雷伯菌碳青霉烯类耐药问题表现日益严峻,合理应用抗菌药物等措施对有效地控制耐碳青霉烯类肺炎克雷伯菌医院感染暴发流行至关重要。OBJECTIVE To investigate the epidemiological characteristics of carbapenem-resistant Klebsiella pneu- rnoniae in a hospital so as to provide guidance for clinical treatment. METHODS A total of 2941 clinical K. pneu- moniae isolates were collected from the clinical departments of the Chinese PLA General Hospital from 2013 to 2015, and the epidemiological characteristics of the K. pneumoniae nosocomial infection were retrospectively ana- lyzed. RESULTS Totally 2941 strains of K. pneumoniae were isolated from 2013 to 2015, of which 358 were resist- ant to carbapenems; the drug resistance rate to carbapenems was 3.79% in 2013, 14.43% in 2014, 14.53% in 2015, showing an upward trend. Of the isolated earbapenem-resistant strains, 34.08 % were isolated from sputum specimens, 16.76 % were isolated from tissues, 14.25 % were isolated from urine specimens, and 11.17 % were i- solated from blood specimens. The strains were only isolated from some of the departments in 2013, however, the carbapenem-resistant K. pneumoniae strains persisted in the hepatobiliary surgery department wards, surgery ICUs, respiratory department ICUs, neurology department ICUs, and respiratory department wards, and the strains were occasionally isolated from other departments. The carbapenem-resistant K. pneumoniae strains were highly resistant to most of the antibiotics except for amikacin, gentamicin, and cotrimoxazole, with the drug re- sistance rate more than 85 %. The carbapenem-sensitive K. pneurnoniae strains maintained high susceptibility to the antibiotics except for ampicillin, with the drug susceptibility rate more than 75 %. CONCLUSION The drug re- sistance of the carbapenem-resistant K. pneumoniae strains is increasingly serious. It is crucial to reasonably use antibiotics so as to effectively control the outbreak and prevalence of the nosocomial infection caused by the carbap- enem-resistant K. pneurnoniae strains.

关 键 词：肺炎克雷伯菌 耐碳青酶烯类 耐药性 

分 类 号：R378.996[医药卫生—病原生物学]