某院耐碳青霉烯类肺炎克雷伯菌检出与耐药表型分布  

Isolation and drug resistance phenotype distribution of carbapenem-resistant Klebsiella pneumoniae in a hospital

作　　者：孙晔佳 顾克菊[1] 

机构地区：[1]上海中医药大学岳阳中西医结合医院,上海200437

出　　处：《中国感染控制杂志》2017年第2期130-133,137,共5页Chinese Journal of Infection Control

基　　金：上海中医药大学校级医院管理研究项目(2016YG16)

摘　　要：目的了解临床分离耐碳青霉烯类肺炎克雷伯菌(CRKP)耐药表型及临床分布特征,为临床合理用药和医院感染防控提供依据。方法收集2013—2015年某医院住院患者临床分离的CRKP,分析标本来源分布及病原菌药敏同源性。结果949株非重复分离的肺炎克雷伯菌中,检出CRKP 75株(7.90%)。2013—2015年CRKP的检出率分别为1.35%、7.77%、17.04%,呈逐年上升趋势,差异有统计学意义(P<0.01)。CRKP感染部位主要为呼吸道和泌尿道,主要分布于重症监护病房(ICU)、老年病科和急诊科。CRKP对阿米卡星和复方磺胺甲口恶唑的敏感率稍高,分别为57.33%、48.00%。CRKP社区获得性感染者22例,占29.33%;医院获得性感染者53例,占70.67%。75例CRKP感染患者死亡18例(24.00%)。耐药表型分析有同源性的CRKP分为5种克隆,主要在ICU、急诊病房和老年病科等科室传播流行。结论CRKP感染的比例有逐年升高的趋势,临床应加强CRKP的监测,采取强化的感染控制措施,预防和控制CRKP的播散和流行。ObjectiveTo analyze drug resistance phenotypes and clinical distribution characteristics of clinically isolated carbapenemresistant Klebsiella pneumoniae（CRKP）, and provide evidence for rational use of antimicrobial agents and control of healthcareassociated infection（HAI）. MethodsCRKP isolated from inpatients in a hospital in 2013-2015 were collected, sources of specimens and homology of antimicrobial susceptibility of pathogens were analyzed. ResultsOf 949 nonrepetitive strains of Klebsiella pneumoniae, 75（7.90%） were CRKP strains. The detection rates of CRKP from 2013 to 2015 were 1.35%, 7.77%, and 17.04% respectively, which showed an upward trend year by year, difference was statistically significant（P〈0.01）. The main infection sites of CRKP were respiratory tract and urinary tract, CRKP mainly distributed in intensive care unit（ICU）, geriatrics and emergency departments. Susceptibility rates of CRKP to amikacin and trimethoprim / sulfamethoxazole were 57.33% and 48.00% respectively. 22 （29.33%） cases of CRKP infection were communityacquired and 53 （70.67%） were healthcareassociated infection. 18 （24.00%）cases died among 75 CRKP infected patients. According to drug resistance phenotype analysis, there were 5 clones of CRKP strains, mainly distributed in ICU, geriatrics and emergency departments.ConclusionThe proportion of CRKP infection is increasing year by year, clinical monitoring on CRKP should be strengthened, intensive infection control measures should be tarken, so as to prevent and control the spread and prevalence of CRKP.

关 键 词：肺炎克雷伯菌 耐碳青霉烯类肺炎克雷伯菌 耐药表型 耐药性 抗药性 微生物 同源性 

分 类 号：R181.32[医药卫生—流行病学] R378.996[医药卫生—公共卫生与预防医学]