2015-2019年我院肺炎克雷伯菌的感染特征与耐药机制  

Infection characteristics and drug resistant mechanism of Klebsiella pneumoniae in our hospital from 2015 to 2019

作　　者：黄晓琳 李明 范晓怡 刘菊珍[1] 黄云祖[1] 李小丽 邹海珠[1] Huang Xiao-lin;Li Ming;Fan Xiao-yi;Liu Ju-zhen;Huang Yun-zu;Li Xiao-li;Zou Hai-zhu(The Center of Clinical Laboratories,the First Affiliated Hospital of Jinan University,Guangzhou 510630;Binhaiwan Central Hospital of Dongguan,Dongguan 523000)

机构地区：[1]暨南大学附属第一医院临床检验中心,广州510630 [2]东莞市滨海湾中心医院,东莞523000

出　　处：《中国抗生素杂志》2021年第5期468-473,共6页Chinese Journal of Antibiotics

摘　　要：目的分析2015—2019年广州暨南大学附属第一医院肺炎克雷伯菌的感染情况和耐药性变迁,并进一步探讨其耐药机制,为临床防治肺炎克雷伯菌感染用药提供实验室依据。方法采用回顾性分析方法,对我院2015—2019年分离的1514株肺炎克雷伯菌进行标本来源、科室分布、耐药性变化等分析,并对其中123株耐碳青霉烯类肺炎克雷伯菌(CRKP)采用改良碳青霉烯类失活法(mCIM)和EDTA碳青霉烯类失活法(eCIM)进行碳青霉烯酶表型筛选试验,并通过PCR方法检测blaKPC、blaVIM、blaIMP和blaNDM4种最常见的碳青霉烯酶耐药基因。结果2015—2019年期间我院肺炎克雷伯菌每年的平均分离率为9.44%,从临床标本分布来看,主要分离自痰液(47.36%)、尿液(23.51%)和血液(16.51%);从临床科室分布来看,分离率最高的依次是ICU病区(17.83%)、呼吸病房(17.83%)和神外病房(9.11%)。肺炎克雷伯菌对碳青霉烯类药物的耐药率相对较低(10%~30%),但在2019年明显上升;对喹诺酮类、头孢类、单环类、四环素类、磺胺类药物耐药率较高(30%~50%);除头孢哌酮/舒巴坦和复方磺胺甲噁唑外,对其他抗菌药物的耐药率均呈上升趋势。123株CRKP中全部菌株mCIM试验阳性(100%),118株检测出blaKPC基因(95.9%),5株eCIM试验阳性(4.1%),均检测出blaIMP基因,未检测出blaVIM和blaNDM基因。结论ICU病区、呼吸病房和神外病房感染肺炎克雷伯菌的情况较为严重,肺炎克雷伯菌对多种抗菌药物的耐药率呈明显上升趋势,mCIM试验和eCIM试验联合检测能够有效筛选产碳青霉烯酶肺炎克雷伯菌,产KPC型碳青霉烯酶是我院肺炎克雷伯菌对亚胺培南和美罗培南耐药的主要机制。Objective To analyze the infection status and drug resistant changes of Klebsiella pneumoniae in the First Affiliated Hospital of Jinan University in Guangzhou from 2015 to 2019,and to further explore the mechanism of drug resistance,so as to provide laboratory evidences for the clinical prevention and treatment of infections caused by Klebsiella pneumoniae.Methods A retrospective analysis was used to analyze the sample source,department distribution,and drug resistance changes of 1514 Klebsiella pneumoniae strains isolated in our hospital from 2015 to 2019,and 123 carbapenem-resistant Klebsiella pneumoniae(CRKP)were also analyzed.Modified carbapenem inactivation method(mCIM)and EDTA carbapenem inactivation method(eCIM)were used for the carbapenemase phenotypic screening test,and PCR was used to detect the four most common carbapenemase resistant genes:blaKPC,blaVIM,blaIMP,and blaNDM.Results The annual average isolation rate of Klebsiella pneumoniae was 9.44%.According to the distribution of clinical specimens,they were mainly isolated from sputum(47.36%),urine(23.51%)and blood(16.51%).From the distribution of clinical departments,the departments with the highest separation rates were the ICU ward(17.83%),followed by the respiratory ward(17.83%),and the neurosurgery ward(9.11%).Klebsiella pneumoniae showed a low resistant rate to carbapenem drugs(10%~30%),and a high resistance rate to quinolones,cephalosporins,monocyclics,tetracyclines,and sulfonamids(30%~50%).Except for cefoperazone/sulbactam and sulfamethoxazole compound,the resistance rate to other antibiotics showed a significant upward trend.All of the 123 CRKP strains were tested positive for mCIM(100%).118 strains were tested positive for the blaKPC gene(95.9%),and five strains were tested positive for eCIM(4.1%).All the five eCIM positvie strains were detected of blaIMP gene,while no blaVIM and blaNDM genes were detected.Conclusion The infection of Klebsiella pneumoniae in ICU ward,respiratory ward,and neurosurgery ward was serious,and the resistant rates

关 键 词：肺炎克雷伯菌 碳青霉烯酶 耐药机制 

分 类 号：R378.2[医药卫生—病原生物学]