医院2011—2018年耐碳青霉烯类肺炎克雷伯菌的分离趋势和耐药性分析  

Isolation rate and drug resistance of carbapenem-resistant Klebsiella pneumoniae in hospital in 2011-2018

作　　者：赵建平 王珊珊 吴忠伟 武芳[3] 张叶毛[4] 李凤兰[5] 邢宝宝 周秀岚[6] Zhao Jianping;Wang Shanshan;Wu Zhongwei;Wu Fang;Zhang Yemao;Li Fenglan;Xing Baobao;Zhou Xiulan(Department of Laboratory Medicine,Inner Mongolia People's Hospital,Hohhot 010010,China;Graduate Student,Clinical Medical School,Inner Mongolia Medical University,Hohhot 010010,China;Department of Gastroenterology,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of Infectious Diseases,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Geriatric Center,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of Pharmacy,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古自治区人民医院检验科,呼和浩特010010 [2]内蒙古医科大学临床医学院,呼和浩特010010 [3]内蒙古医科大学附属医院消化内科,呼和浩特010050 [4]内蒙古医科大学附属医院感染科,呼和浩特010050 [5]内蒙古医科大学附属医院老年医学中心,呼和浩特010050 [6]内蒙古医科大学附属医院药剂部,呼和浩特010050

出　　处：《中国医药》2019年第12期1891-1895,共5页China Medicine

基　　金：内蒙古自治区自然科学基金(2017MS08144)~~

摘　　要：目的通过对2011-2018年耐碳青霉烯类肺炎克雷伯菌(CR-KP)的分离情况和耐药现状进行分析,指导临床合理用药。方法收集2011年1月至2018年12月在内蒙古自治区人民医院就医患者中分离出的肺炎克雷伯菌3 301株,其中CR-KP(对亚胺培南或美罗培南中任何一种耐药) 289株,非耐碳青霉烯类肺炎克雷伯菌(non-CR-KP) 2 988株,24株未做亚胺培南和美罗培南的药敏试验。统计菌株分离率、标本来源和病区分布,对CR-KP和non-CR-KP的耐药率进行对比分析。结果 2011-2018年各年度检出CR-KP占肺炎克雷伯菌比例分别为0、1. 5%(4/268)、0. 3%(1/289)、0、0. 6%(2/313)、0. 2%(1/469)、3. 2%(18/565)和26. 5%(263/991),平均8. 8%(289/3 301);2016-2018年CR-KP呈增长趋势,差异有统计学意义(P <0. 05)。CR-KP检出比例最高的科室为重症监护病房(25. 5%),最高的标本为尿液(13. 8%)。289株CR-KP的主要科室来源(构成比)为重症监护病房(33. 9%),主要标本来源为痰液(48. 4%)。CR-KP除对复方新诺明的耐药率为78. 9%外,对其他18种抗菌药物的耐药率均很高(91. 3%~100%),而non-CR-KP对19种抗菌药物的耐药率均较低(0~34. 8%)。CR-KP对19种抗菌药物的耐药率均明显高于non-CR-KP,差异均有统计学意义(均P <0. 001)。结论本院2011-2018年CR-KP的检出率呈增长趋势,CR-KP对大多数抗菌药物的耐药程度严重;临床应加强感染的相关知识学习,做到CR-KP的早监测、早控制和早治疗。Objective To analyze the isolation rate and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CR-KP)in 2011-2018 and to provide guidance for rational drug use.Methods From January 2011 to December 2018,3301 strains of Klebsiella pneumoniae were isolated from patients in Inner Mongolia People’s Hospital,including 289 strains of CR-KP(resistant to either imipenem or meropenem)and 2988 strains of non-CR-KP;24 strains did not have drug sensitivity test.Detection rate,specimen source and ward distribution of bacterial strains were counted.Drug resistance rates of CR-KP and non-CR-KP to major anti-bacterial agents were analyzed.Results Annual rates of CR-KP to Klebsiella pneumoniae were 0,1.5%(4/268),0.3%(1/289),0,0.6%(2/313),0.2%(1/469),3.2%(18/565)and 26.5%(263/991),respectively,with an average of8.8%(289/3301)in 2011-2018,and the rate showed a significant increasing trend in 2016-2018(P<0.05).The highest rate of CR-KP was found in intensive care unit(25.5%)and urine(13.8%).The main source(constituent ratio)of CR-KP was intensive care unit(33.9%)and sputum(48.4%).CR-KP showed high resistance rates to 18 kinds of antimicrobial agents(91.3%-100%);the resistance rate to compound trimethoprim was relatively low(78.9%).Resistance rates of non-CR-KP to 19 kinds of antimicrobial agents(0-34.8%)were significantly lower than those of CR-KP(all P<0.001).Conclusions Isolation rate of CR-KP increased in2011-2018.CR-KP is resistant to most antibiotics.Early monitoring,control and treatment measures should be strengthened for CR-KP infection.

关 键 词：肺炎克雷伯菌 碳青霉烯类 亚胺培南 多重耐药 

分 类 号：R446.5[医药卫生—诊断学]