耐碳青霉烯类肺炎克雷伯菌的临床分布及耐药性分析  

Clinical distribution and drug resistance analysis of carbapenem-resistant Klebsiella pneumoniae

作　　者：沈翠芬[1] 张晓祥[1] 辛少军[1] 汪艳[1] 金银[1] SHEN Cui-fen;ZHANG Xiao-xiang;XIN Shao-jun;WANG Yan;JIN Yin(Clinical Laboratory,Huzhou Central Hospital,Huzhou,Zhejiang 313000,China)

机构地区：[1]浙江省湖州市中心医院检验科,浙江湖州313000

出　　处：《中国卫生检验杂志》2020年第23期2838-2840,共3页Chinese Journal of Health Laboratory Technology

基　　金：“十三五”国家科技重大专项(2017ZX10103008-005)。

摘　　要：目的了解本院耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床分布及耐药特点,为临床CRKP治疗药物的选择提供依据。方法回顾性分析2016年-2018年分离的CRKP的临床分布及药敏结果,细菌分离培养严格按照《全国临床检验操作规程》,细菌鉴定和药敏试验采用VITEK 2全自动细菌鉴定药敏系统。结果筛选出CRKP 596株,标本中以痰液最多,占69.0%,其次为尿液,占10.7%;科室分布以重症医学科最多,占69.1%,其次为神经外科,占7.6%。CRKP对除碳青霉烯类以外的其他常用抗菌药物的耐药率均较高,对哌拉西林/他唑巴坦、头孢他定、头孢曲松等几乎都耐药,仅对替加环素保持很好的敏感性,其耐药率在10.0%以下。结论痰液标本为CRKP的主要来源,且多种药物对CRKP临床治疗效果不明显,医院应加强对抗生素的合理使用,加强对CRKP耐药性的监测,以药敏结果来指导临床用药,能有效避免耐药菌株的出现,减少临床医生用药的困难。Objective To understand the clinical distribution and drug resistance characteristics of Klebsiella pneumoniae( CRKP) resistant to carbapenems in our hospital,so as to provide basis for the selection of clinical CRKP drugs.Methods Clinical distribution and drug sensitivity of CRKP isolated from 2016 to 2018 were retrospectively analyzed. The isolation and culture of bacteria were strictly in accordance with the national guide to clinical laboratory procedures. Bacterial identification and drug susceptibility tests were performed by VITEK 2 automatic bacterial identification drug susceptibility system. Results A total of 596 strains of CRKP were screened out,with the most sputum in the specimens,accounting for69. 0%,followed by urine,accounting for 10. 7%. The department of intensive care medicine was the largest,accounting for69. 1%,followed by neurosurgery,accouting for 7. 6%. The resistance rate of CRKP to other commonly used antibacterial drugs except carbapenems was relatively high,and it was almost resistant to piperacillin/tazobactam,ceftazidime,ceftriaxone.It only maintained highly sensitivity to tegacycline,and its resistance rate was below 10. 0%. Conclusion Sputum specimens were the main source of CRKP,and many drugs were not effective in clinical treatment of CRKP. The hospital should strengthen the rational use of antibiotics and the monitoring of CRKP resistance,and the results of drug were good at guiding the clinical use,which can effectively avoid the emergence of drug-resistant strains and reduce the difficulty for clinicians to use drugs.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 抗菌药物 耐药性分析 

分 类 号：R446.5[医药卫生—诊断学]