2015-2019年耐碳青霉烯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 from 2015 to 2019

作　　者：曹身云 刘晶[2] 李震[1] 张志军[1] 姜梅杰[1] 赵书平[1] CAO Shenyun;LIU Jing;LI Zhen;ZHANG Zhijun;JIANG Meijie;ZHAO Shuping(Department of Clinical LaboratoryTai′an City Central Hospital,Tai′an,Shandong 271000,China;Discipline Construction Office,Tai′an City Central Hospital,Tai′an,Shandong 271000,China)

机构地区：[1]泰安市中心医院检验科,山东泰安271000 [2]泰安市中心医院学科建设办公室,山东泰安271000

出　　处：《国际检验医学杂志》2021年第5期563-567,共5页International Journal of Laboratory Medicine

基　　金：山东省自然科学基金项目(ZR2016HL44);山东省保健科技协会科学技术课题(SDBJKT20180033);泰安市科学技术发展计划(2019NS213)。

摘　　要：目的了解2015-2019年该院耐碳青霉烯肺炎克雷伯菌(CRKP)的检出情况及耐药性,为临床合理使用抗菌药物提供理论依据。方法回顾性分析2015-2019年该院检出的非重复CRKP 326株。利用美国贝克曼Microscan WalkAway 96plus全自动微生物鉴定药敏系统进行菌株鉴定和药敏试验。菌株分布及耐药率使用WHONET5.6软件进行统计分析,检出率及耐药率的比较采用SPSS23.0统计软件进行分析。结果5年间该院共分离出非重复肺炎克雷伯菌(KP)3905株,其中CRKP 326株,总检出率为8.35%,各年度的检出率依次为6.83%(44/644)、6.85%(45/657)、9.60%(75/781)、10.29%(98/952)、7.35%(64/871)。CRKP主要分离自痰液、尿液、血液标本。主要分布科室为各监护室病房,包括重症医学科、儿科监护室、神经外科监护室、急诊科监护室、呼吸重症科。CRKP对大多数临床常用抗菌药物高度耐药,对头孢类耐药率为100.0%,对酶的抑制剂和氨曲南耐药率大于95.0%,对喹诺酮类耐药率大于75.0%,对氨基糖苷类和复方磺胺甲噁唑的耐药率为62.0%~72.0%,对替加环素和多黏菌素B耐药率最低。结论该院CRKP检出率较高,耐药情况严峻,医护人员要注意手卫生和院感的防控,防止CRKP暴发流行。Objective To investigate the detection and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)in a hospital from 2015 to 2019,and to provide theoretical basis for rational use of antibiotics in clinical practice.Methods Retrospective analysis was performed on 326 non-repetitive CRKP isolated in our hospital from January 2015 to December 2019.Bacterial identification and susceptibility testing were carried out by Microscan WalkAway 96plus automatic bacterial analyzer(Beckman,USA).WHONET5.6 software was used for statistical analysis of strain distribution and drug resistance rate.SPSS23.0 statistical software was used for comparison of detection rate and drug resistance rate.Results In the past five years,3905 strains of Klebsiella pneumoniae(KP)were isolated in our hospital,among which 326 strains of CRKP were isolated with an overall detection rate of 8.35%.The annual detection rates were 6.83%(44/644),6.85%(45/657),9.60%(75/781),10.29%(98/952)and 7.35%(64/871)respectively.CRKP was mainly isolated from sputum,urine and blood samples.The main departments were critical care wards,including intensive care unit,pediatric intensive care unit,neurosurgery intensive care unit,emergency care unit and respiratory intensive care unit.CRKP was highly resistant to most commonly used antibiotics in clinical.The resistance rate to cephalosporin was 100.0%,to enzyme inhibitors and aztreonam was over 95.0%,to quinolones was over 75.0%,to aminoglycosides and cotrimoxazole was 62.0%-72.0%,and to Tigecycline and polymyxin B were the lowest.Conclusion The detection rate of CRKP in a hospital is high and the drug resistance is severe.The medical staff should pay attention to hand hygiene and prevention and control of hospital sensation to prevent the outbreak of CRKP.

关 键 词：耐碳青霉烯肺炎克雷伯菌 临床分布 耐药性 

分 类 号：R446.5[医药卫生—诊断学]