2015—2019年某三甲医院肺炎克雷伯菌耐药变迁情况  

Drug resistance of Klebsiella pneumoniae in a tertiary hospital from 2015 to 2019

作　　者：张珂 蒋玉婷 刘唐娟[1] 孔晋亮[1] 黄莹莹[1] 温中薇[1] 陈一强[1] Zhang Ke;Jiang Yuting;Liu Tangjuan;Kong Jinliang;Huang Yingying;Wen Zhongwei;Chen Yiqiang(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院呼吸与危重症医学科,南宁530021

出　　处：《广西医科大学学报》2021年第5期1050-1054,共5页Journal of Guangxi Medical University

基　　金：国家自然科学基金资助项目(No.81760743);广西壮族自治区卫生健康委员会自筹经费科研项目(No.:Z20190940)。

摘　　要：目的:通过对广西医科大学第一附属医院近2015—2019年肺炎克雷伯菌(KP)耐药趋势及变迁情况的分析,为更好的指导临床诊疗提供理论依据。方法:回顾性分析本院2015年1月到2019年12月住院的421例患者中分离出的502株KP菌株,比较不同年份菌株的科室分布、标本类型以及耐药率变迁情况。结果:痰标本(47.01%)和血液标本(26.29%)是分离出KP的主要标本来源。重症监护病房(ICU)(14.74%)、儿科(13.35%)、血液内科(10.16%)、呼吸内科(9.76%)和新生儿科(9.76%)是KP感染最常检出的几个科室。2015—2019年KP对β-内酰胺类抗生素耐药率呈下降趋势,尤其是头孢他啶、头孢曲松和头孢唑啉(χ^(2)=11.964,P=0.018;χ^(2)=11.462,P=0.022;χ^(2)=11.156,P=0.025)。产超广谱β-内酰胺酶(ESBLs)KP的检出率存在波动,2015—2016年呈上升趋势、2016—2017年呈下降趋势、2017—2018年呈上升趋势、2018—2019年呈下降趋势(χ^(2)=11.783,P=0.019)。KP对亚胺培南的耐药率2015—2017呈上升趋势、2017—2019呈下降趋势(χ^(2)=10.736,P=0.030)。多重耐药(MDR)KP检出率呈逐年降低的趋势,由2015年的72.22%降低到了2019年的52.38%。结论:本院对β-内酰胺类抗生素、碳青霉烯类药物的控制有待进一步加强。临床应加强对KP的耐药性进行监测,减少耐药KP菌株的出现、传播。Objective:To analyze the trend and changes of drug resistance of Klebsiella pneumoniae(KP)in our hospital in recent five years,so as to provide theoretical basis for better guidance of clinical diagnosis and treatment.Methods:A total of 502 strains of KP isolated from 421 patients in our hospital from January 2015 to December 2019 were retrospectively analyzed,and the departmental distribution,specimen types and drug resistance rates of the strains in different years were compared.Results:Sputum samples(47.01%)and blood samples(26.29%)were the main sources of KP.Intensive care unit(ICU)(14.74%),pediatrics(13.35%),hematology(10.16%),respiratory medicine(9.76%)and neonatal pediatrics(9.76%)were the departments most frequently detected for KP infection.From 2015 to 2019,the resistance rate of KP toβ-lactam antibiotics decreased,especially to ceftazidime,ceftriaxone and cefazolin(χ^(2)=11.964,P=0.018;χ^(2)=11.462,P=0.022;χ^(2)=11.156,P=0.025).The detection rate of extended-spectrumβ-lactamase(ESBLs)KPfluctuated,showing an upward trend in 2015-2016,a downward trend in 2016-2017,an upward trend in 2017-2018,and a downward trend in 2018-2019(χ^(2)=11.783,P=0.019).The resistance rate of KP to imipenem increased from 2015 to 2017 and decreased from 2017 to 2019(χ^(2)=10.736,P=0.030).The detection rate of multiple drug resistance(MDR)KP decreased year by year,from 72.22%in 2015 to 52.38%in 2019.Conclusion:The control ofβ-lactam antibiotics and carbapenems in our hospital should be further strengthened.The drug resistance of KP should be monitored to reduce the emergence and transmission of drug-resistant KPstrains.

关 键 词：肺炎克雷伯菌 耐药性 Β-内酰胺酶 碳青霉烯酶 

分 类 号：R446.5[医药卫生—诊断学]