近6年新生儿科血培养分离肺炎克雷伯菌的耐药性变化  

Changes in antimicrobial resistance of Klebsiella pneumoniae isolated from blood culture of neonates in recent 6 years

作　　者：杨帆[1] 张敏[1] 程玲[1] 王杨[1] 王琍琍[1] YANG Fan;ZHANG Min;CHENG Ling;WANG Yang;WANG Lili(The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《西北药学杂志》2021年第6期1005-1009,共5页Northwest Pharmaceutical Journal

基　　金：国家自然科学基金青年基金项目(编号:81801831)。

摘　　要：目的了解新生儿科血标本分离的肺炎克雷伯菌(KP)耐药性变化并结合抗菌药物使用情况指导用药。方法对2014~2019年新生儿科送检的血培养结果及该院抗菌药物使用情况进行分析。结果KP是血培养检出率最高(0.9%)的3种病原菌之一。6年中前后3年对比,后3年产超广谱β内酰胺酶(ESBLs)的KP(18例)明显减少(P<0.01),氨苄青霉素舒巴坦、头孢唑啉、头孢噻肟、头孢他啶、头孢曲松、头孢吡肟、氨曲南和庆大霉素耐药性也显著降低(P<0.05)。前、后3年耐药率分别为:氨苄青霉素(100%、93.3%),头孢哌酮舒巴坦(14.3%、17.7%),哌拉西林舒巴坦(6.7%、24.1%),美罗培南(0.0%、14.3%),亚胺培南(0.0%、14.3%),阿米卡星(0.0%、3.3%),环丙沙星(16.7%、10.0%),左氧氟沙星(3.5%、3.3%),前后3年对比差异无统计学意义。新生儿科抗菌药物使用强度明显下降,但特殊限制级抗菌药物使用率和使用强度逐渐接近甚至超过全院水平。结论新生儿科血培养分离的KP对大多数的青霉素类和头孢类抗生素耐药。近3年耐药情况有所改善,应重视并控制特殊限制级抗菌药物的使用,碳青霉烯类、氨基糖苷类、喹诺酮类和部分酶抑制剂类耐药性低,仍应加强监管。Objective To evaluate the change of antimicrobial resistance of Klebsiella pneumoniae(KP)isolated from blood culture of neonates,and guide the use of antibiotics.Methods The blood culture results and the use of antibiotics in the neonatal department from 2014 to 2019 were analyzed.Results KP was one of the 3 pathogens with the highest detection rate(0.9%)in blood culture.The KP of ESBLs(n=18)decreased significantly in the last 3 years(P<0.01).The antimicrobial resistance of ampicillin/sulbactam,cefazolin,cefotaxime,ceftazidime,ceftriaxone,cefepime,aztreonam,and gentamicin decreased significantly in the last 3 years(P<0.05).The antimicrobial resistance in the first and last 3 years was ampicillin(100%,93.3%),cefoperazone Sodium and sulbactam Sodium(14.3%,17.7%),piperacillin/sulbactam(6.7%,24.1%),meropenem(0.0%,14.3%),imipenem(0.0%,14.3%),amikacin(0.0%,3.3%),ciprofloxacin(16.7%,10.0%),and levofloxacin(3.5%,3.3%)respectively.The difference between the first and last 3 years was not statistically significant.The use intensity of antibiotics in the neonatal department decreased significantly,but the utilization rate and the use intensity of special restricted antibiotics in the neonatal department gradually approached or even exceeded the level of the whole hospital.Conclusion KP isolated from the blood culture of the neonatal department is resistant to most penicillins and cephalosporins.Antibiotic resistance declined in the last 3 years,and more attention should be paid to the control of the use of special restricted antibiotics.The resistance of carbapenems,aminoglycosides,quinolones,and some enzyme inhibitors is low,but attention should be paid to the use of special restricted antibiotics.

关 键 词：抗菌药物 肺炎克雷伯菌 耐药 新生儿 血培养 

分 类 号：R969.3[医药卫生—药理学]