2012年至2019年肺炎克雷伯菌儿童感染的临床分布及耐药性分析  

Analysis of the clinical distribution and drug resistance of Klebsiella pneumoniae infected in children from 2012 to 2019

作　　者：周艳[1] 周树平[1] 彭军[1] 闵亮[1] 段荣[1] 余晓君[1] 柯江维[1] ZHOU Yan;ZHOU Shuping;PENG Jun;MIN Liang;DUAN Rong;YU Xiaojun;KE Jiangwei(Department of clinical laboratory,jiangxi children's hospital,Nan Chang,330006,JiangXi Province,China)

机构地区：[1]江西省儿童医院检验科,江西南昌330006

出　　处：《实验与检验医学》2021年第6期1360-1364,共5页Experimental and Laboratory Medicine

基　　金：江西省科技计划项目(NO.20195589)。

摘　　要：目的分析江西地区8年间儿童患者临床分离的肺炎克雷伯菌的临床分布及对常见抗菌药物的耐药性,为合理使用抗菌药物以及预防院内感染提供依据。方法收集江西省儿童医院2012年1月至2019年12月各类临床标本分离的688株肺炎克雷伯菌,使用Whonet 5.6软件对常用抗菌药物的耐药性情况进行分析及对其临床分布进行统计分析。结果688株肺炎克雷伯菌在2012年至2019年各年度革兰阴性菌中的平均比例为6.2%,主要分离自外科病房(32.1%)、重症监护病房(19.6%)和新生儿病房(13.2%),以血液(46.5%)标本为主;产ESBLs株阳性检出率及耐碳青霉烯类菌株检出率分别为56.7%和21.8%。肺炎克雷伯菌对三代头孢菌素的耐药率平均维持在50%以上,对哌拉西林/他唑巴坦的耐药率高达54%;对亚胺培南和美洛培南耐药率出现明显变化,2012年至2014年耐药率在10.6%~19.5%波动,2015年出现明显上升,且2015年至2017年保持高水平耐药率在40.8%~46.3%。对阿米卡星、左氧氟沙星和复方新诺明的耐药率分别为7.7%、7.7%和41.7%。耐碳青霉烯的肺炎克雷伯菌对常见抗菌药物呈高度耐药性。结论江西地区儿童患者肺炎克雷伯菌的临床分离率较高,8年间,耐药率发生较大幅度增加,菌株越来越具有多重耐药的特点,耐药情况严重,且CRKP检出率较高,应加强儿童抗菌药物合理使用以及院感防控。Objective To analyze the distribution and antimicrobial resistance of Klebsiella pneumoniae isolated from pediatric patients in Jiangxi province children's hospital in the past 8 years,providing the evidence to prevent hospital-acquired infection using reasonable antimicrobial agents.Methods A total of 688 strains of Klebsiella pneumoniae isolated from various clinical specimens from Children's Hospital of Jiangxi Province from January 2012 to December 2019 were collected.Whonet 5.6 software was used to analyze the drug resistance of common antibacterial drugs and statistical analysis of their clinical distribution.Results The Klebsiella pneumoniae isolates accounted for6.2%of Gram-negative bacteria during investigation period.The majority of Klebsiellae pneumoniae were isolated from the surgical ward(32.1%),intensive care ward(19.6%)and neonatal ward(13.2%),and were mainly isolated from blood(46.5%).The positive rates of extended spectrum beta lactamases(ESBLs)producing and imipenem-resistant isolates were 56.7%and 21.8%,respectively.The drug resistance rate of Klebsiella pneumoniae to cephalosporins of three generations was above 50%on average,and the drug resistance rate of piperacillin/tazobactam was as high as 54%.The drug resistance rate of imipenem and Meropenem showed significant changes.From 2012 to 2014,the drug resistance rate fluctuated from 10.6%to 19.5%,which increased significantly in 2015,and maintained a high level of drug resistance rate from 2015 to 2017,which was 40.8%to 46.3%.The drug resistance rates of amikacin,levofloxacin and cotrimoxazole were 7.7%,7.7%and 41.7%,respectively.Carbapene-resistant Klebsiella pneumoniae is highly resistant to common antimicrobial agents.Conclusion The resistance rates of klebsiella pneumonia in children were high.During the past 8 years,the resistance to increase considerably and the strain is increasingly multidrug-resistant and serious of the resistance.In addition,the detection rate of CRKP was high.Therefore,it is necessary to strength rational applicati

关 键 词：儿童 肺炎克雷伯菌 耐药性 耐碳青霉烯类肺炎克雷伯菌 医院感染 

分 类 号：R517.6[医药卫生—内科学]