分离自血培养肺炎克雷伯菌的耐药性及临床特征分析  

Antibiotic resistance profile and clinical characteristics of the Klebsiella pneumoniae strains isolated from blood cultures

作　　者：管红艳 俞静[1] 刘婧娴[1] 朱威南 余佳佳[1] 刘瑛[1] GUAN Hongyan;YU Jing;LIU Jingxian;ZHU Weinan;YU Jiajia;LIU Ying(Department of Laboratory Medicine,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院检验科微生物室,上海200092

出　　处：《中国感染与化疗杂志》2018年第6期608-613,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解上海交通大学医学院附属新华医院近9年分离自血培养标本的肺炎克雷伯菌耐药性变迁情况,为临床合理使用抗菌药物提供参考依据。方法回顾性分析该院2009-2017年分离自住院患者血培养标本的肺炎克雷伯菌耐药性情况,并收集患者相关的临床资料进行统计分析。结果 2009-2017年分离自血培养标本的菌株共6917株,肺炎克雷伯菌311株,占4.5%,其中298株菌株进行完整的药敏试验,结果显示对抗菌药物的耐药率呈整体上升趋势,对哌拉西林-他唑巴坦、头孢替坦及碳青霉烯类的耐药率由2009年的0上升至2017年的48.6%。耐碳青霉烯类肺炎克雷伯菌(CRKP)检出率总体呈上升趋势,2009年检出率为0,2017年达48.7%。血培养肺炎克雷伯菌住院患者主要分布于普外科、心胸外科、急诊科、儿外科等科室。与非CRKP组住院患者相比,CRKP组患者在入院后血培养检出肺炎克雷伯菌时间、抗菌药物暴露、侵袭性操作、住院天数及预后方面与前者的差异均有统计学意义(P<0.001)。结论 2009-2017年,血培养分离的肺炎克雷伯菌耐药性整体呈现逐渐严重趋势。微生物实验室应加强此类菌株的耐药性监测,临床医师尽可能减少侵袭性操作,并合理选用抗菌药物,以减少耐药菌株的出现。Objective To analyze the changing antibiotic resistance profile of the Klebsiella pneumoniae strains isolated from blood cultures during the last 9 years in our hospital for rational use of antibiotics.Methods Antibiotic resistance of the K.pneumoniae strains isolated from blood cultures from 2009 to 2017 was retrospectively analyzed.Medical records of the corresponding inpatients were reviewed and analyzed.Results A total of 6 917 bacterial strains were isolated from blood cultures between 2009 and 2017,of which 311 strains(4.5%)were Klebsiella pneumoniae.Complete antimicrobial susceptibility data were available for 298 of the 311 strains.The K.pneumoniae strains isolated from blood cultures showed increasing resistance rate to the antimicrobial agents in the nine-year period.The resistance rates to piperacillin-tazobactam,cefotetan,amikacin,carbapenem antibiotics increased from 0 to 48.6%.The prevalence of CRKP increased from 0 in 2009 to 48.7%in 2017.The inpatients with K.pneumoniae isolate from blood cultures were mainly found in general surgery,cardio-thoracic surgery department,emergency room,and pediatrics surgery department.Significant difference was found between CRKP-associated inpatients and non-CRKPassociated inpatients in the time to detection of K.pneumoniae,exposure to antimicrobial agents,invasive procedure,length of hospital stay,and prognosis(P<0.001).Conclusions The antibiotic resistance profile of the K.pneumoniae strains isolated from blood cultures showed a rising tendency during the period from 2009 to 2017.Clinical microbiology laboratory should pay more attention to strengthening antibiotic resistance surveillance.Clinicians should reduce the use of invasive procedures and use appropriate antimicrobial agents to prevent the emergence of antibiotic-resistant strains.

关 键 词：血培养 肺炎克雷伯菌 耐药性 临床特征 

分 类 号：R378[医药卫生—病原生物学]