2017-2018年分离肺炎克雷伯菌的临床分布与耐药性分析  

Clinical distribution and drug resistance of Klebsiella pneumoniae isolated from 2017 to 2018

作　　者：程科萍[1] 孔庆芳[1] 王长娴[1] 王静[1] CHENG Ke-ping;KONG Qing-fang;WANG Chang-xian;WANG Jing(ZhongDa Hospital Affiliated to Southeast University,Nanjing,Jiangsu 210009,China)

机构地区：[1]东南大学附属中大医院感染管理科

出　　处：《中华医院感染学杂志》2019年第20期3068-3072,共5页Chinese Journal of Nosocomiology

基　　金：国家自然基金资助项目(81673147);中华医院感染控制研究基金资助项目(ZHYY2013-11);中国疾病预防控制中心标准立项基金资助项目{中疾控标准NO【2019】458号}

摘　　要：目的了解某三甲综合医院2017-2018年分离肺炎克雷伯菌分布情况及细菌耐药性特点,为临床科室有效控制肺炎克雷伯菌感染及抗菌药物的合理使用提供依据。方法对东南大学附属中大医院2017-2018年主要标本类型(痰液、血液、尿液等)来源分离的非重复肺炎克雷伯菌和不同病区分离的肺炎克雷伯菌的耐药性进行回顾性分析。结果临床送检的各类标本共检出肺炎克雷伯菌1391株,其中痰液745株占53.56%、血液193株占13.87%、尿液183株占13.16%和分泌物106株占7.62%,分别位居前四位。重症监护病房(ICU)分离率最高为30.84%(429/1391),其次为神经内科8.20%(114/1391)和呼吸内科7.62%(106/1391)。不同标本来源的肺炎克雷伯菌对氨苄西林/舒巴坦、头孢唑林、头孢曲松、氨曲南、呋喃妥因及环丙沙星耐药率较高。不同科室肺炎克雷伯菌抗菌药物使用中厄他培南、头孢西丁、呋喃妥因及环丙沙星耐药率差异无统计学意义;其他抗菌药物耐药率差异有统计学意义(P<0.05)。不同标本来源的肺炎克雷伯菌对头孢哌酮/舒巴坦、头孢替坦、厄他培南、头孢西丁、妥布霉素的耐药率差异无统计学意义;其他抗菌药物耐药率有统计学差异(P<0.05)。结论肺炎克雷伯菌耐药现象严重,尤其是近年来耐碳青霉烯类抗菌药物的肺炎克雷伯菌增加;临床及时了解不同来源肺炎克雷伯菌的临床分布特点和耐药性,在诊疗工作中采取合理有效的防范措施降低肺炎克雷伯菌感染风险。OBJECTIVE To study the clinical distribution and drug resistance of Klebsiella pneumoniae isolated from one grade A hospital from 2017to 2018,so as to provide the guidance for the effective control of K pneumoniae infection and the rational use of antibiotics in clinical departments.METHODS The drug resistance of K pneumoniae isolated from 2017to 2018from sputum,blood and urine and different areas in Zhongda Hospital.Affiliated to Southeast University were retrospectively analyzed.RESULTS A total of 1391strains of K pneumoniae were detected in all kinds of clinical specimens,including 745strains of sputum(53.56%),193strains of whole blood(13.87%),183strains of urine(13.16%)and 106strains of secretions(7.62%).The departments were mainly distributed in the intensive care unit(ICU),accounting for 30.84%(429/1391),followed by 8.20%(114/1391)in the neurology department and 7.62%(106/1391)in the respiratory department.The resistance rates of K pneumoniae isolated from different specimens sources to ampicillin/sulbactam,cefazolin,ceftriaxone,aztreonam,nitrofurantoin and ciprofloxacin were higher than other drugs.There was no significant difference in the resistance rates of etanercept,cefoxitin,furantoin and ciprofloxacin among different departments,whereas there was significant difference in resistance rate of other antimicrobials(P<0.05).The drug resistance rates of cefoperazone/sulbactam,cefotetan,ertapenem,cefoxitin and tobramycin were not significantly different among different samples,whereas those of other antibacterial drugs were significantly different(P<0.05).CONCLUTIONThe drug resistance of Kpneumoniaeis serious,especially in recent years,the carbapenem-resistant K pneumoniae increased significantly.Clinicians should timely understand the drug resistance of K pneumoniae from different sources,and take reasonable and effective preventive measures to reduce the risk of K pneumoniae infection in diagnosis and treatment of K pneumoniae.

关 键 词：肺炎克雷伯菌 耐碳青霉烯类 耐药性 抗菌药物 

分 类 号：R378.996[医药卫生—病原生物学]