天津某三甲医院耐碳青霉烯类肺炎克雷伯菌临床分布及耐药分析  

Clinical distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae strains isolated from a three-A hospital

作　　者：刘洁[1] 杨晶[1] 高立芳[1] 杨亚敏[1] LIU Jie;YANG Jing;GAO Li-fang;YANG Ya-min(The Third Central Hospital of Tianjin,Tianjin Key Laboralory of Extracorporeal Life Support for Critical Diseases Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院感染疾病科天津市重症疾病体外生命支持重点实验室天津市人工细胞工程技术研究中心天津市肝胆研究所,天津300170

出　　处：《中华医院感染学杂志》2020年第14期2139-2143,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81572268)。

摘　　要：目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床分布及耐药情况,为CRKP的治疗及防控提供参考。方法收集2015年1月-2018年12月天津市第三中心医院分离的235株CRKP,分析历年检出率、标本来源、科室分布、并判断菌株的社区感染、定植、医院感染情况,耐药性与碳青霉烯类药物使用频度的相关性。结果2015-2018年共分离肺炎克雷伯菌4 112株,其中耐碳青霉烯类菌株235株,各年检出率分别为2.94%、4.49%、5.45%、9.64%,呈逐年上升趋势(P<0.001)。CRKP感染部位主要为呼吸道,与非呼吸道相比差异有统计学意义(P<0.05)。其次为泌尿道、血流感染,但呼吸道感染率逐年下降,而泌尿道、血流感染构成比逐年升高。CRKP主要分布在重症监护病房(ICU),与非ICU相比差异有统计学意义(P<0.001),其次科室为肝外科、呼吸科、肿瘤科。但ICU构成比逐年下降,普通科室构成比逐年上升。CRKP感染中医院感染占比最大,其次为社区感染,但医院感染构成比逐年下降,社区感染和定植比例逐年上升。CRKP对多种抗菌药物呈高耐药,仅对替加环素、庆大霉素、阿米卡星、多黏菌素B、磺胺甲噁唑/甲氧苄啶、妥布霉素耐药率<70%。CRKP检出率与碳青霉烯类药物使用频度呈正相关(P<0.001)。结论 CRKP检出率逐年上升,不仅是在呼吸道、ICU病区及医院感染患者中,而且在非呼吸道、非ICU病区及社区感染患者中也上升明显,CRKP的升高与碳青霉烯类抗菌药物使用频度相关,应加强相关方面的防控,治疗时需联合用药。OBJECTIVE To investigate the clinical distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains so as to provide guidance for prevention and control of CRKP.METHODS Totally 235 strains of CRKP were isolated from the Third Central Hospital of Tianjin from Jan 2015 to De 2018.The isolation rates of strains,sources of specimens,distribution of departments,incidence of community-acquired infections,colonization and nosocomial infection were observed,and the correlation between drug resistance and DDDs were analyzed.RESULTS A total of 4112 strains of K.pneumoniae were isolated,235 of which were carbapenem-resistant strains;the isolation rate was 2.94%in 2015,4.49%in 2016,5.45%in 2017,9.64%in 2018,showing an upward trend(P<0.001).The respiratory tract was the major site of CRKP infection,as compared with the non-respiratory tract,there was significant difference(P<0.05),followed by the urinary tract and bloodstream infections,however,the incidence of respiratory tract infection was decreased year by year,while the constituent ratios of the patients with urinary tract and bloodstream infections were increased year by year.The CRKP strains were mainly isolated from the intensive care unit(ICUs),as compared with the non-ICUs,there was significant difference(P<0.001),followed by the liver surgery department,respiratory department and oncology department;while the constituent ratios of the ICUs were decreased year by year,the constituent ratios of the common departments were increased year by year.The percentage of the patients with nosocomial CRKP infection was the highest,followed by the percentage of the patients with community-acquired infection;however,the constituent ratios of the patients with nosocomial infection were decreased year by year,and the percentages of the patients with community-acquired infection and colonization were increased year by year.The CRKP strains were highly resistant to multiple antibiotics,and the drug resistance rates to tigecycline,gentamicin,amikacin,pol

关 键 词：肺炎克雷伯菌 耐药监测 碳青霉烯酶 抗菌药物 

分 类 号：R378.996[医药卫生—病原生物学]