2017-2021年某三甲医院肺炎克雷伯菌分布及耐药性  

Distribution and drug resistance of Klebsiella pneumoniae strains isolated from a three-A hospital in 2017-2021

作　　者：李丽芝 陈菁[1] 宁耀贵[1] 孙杰 LI Li-zhi;CHEN Jing;NING Yao-gui;SUN Jie(The First Affiliated Hospital of Xiamen University,Xiamen,Fujian 361003,China)

机构地区：[1]厦门大学附属第一医院重症医学科,福建厦门361003

出　　处：《中华医院感染学杂志》2022年第18期2730-2733,共4页Chinese Journal of Nosocomiology

基　　金：福建省自然科学基金卫生联合面上项目(2020J011237)厦门市医疗卫生指导性项目(3502Z20209019)。

摘　　要：目的了解住院患者分离肺炎克雷伯菌(KPN)分布特征及耐药性,旨在为临床提供防治感染的依据,以便更好地协助临床用药。方法收集2017年1月-2021年12月厦门大学附属第一医院临床常规分离菌株,采用纸片扩散法进行抗菌药物敏感试验,纸片法初筛和酶抑制剂增强纸片法确证测定超广谱β-内酰胺酶(ESBLs),采用WHONET5.5和SPSS26.0软件进行数据统计分析。结果2017年1月-2021年12月共检出KPN 814株,ICU检出率最高(26.66%);主要来源于痰液(32.80%)、血液(24.57%)和尿液标本(20.64%);产ESBLs菌株和耐碳青霉烯类肺炎克雷伯菌(CRKP)5年平均检出率为33.05%和15.11%;肺炎克雷伯菌对头孢菌素的耐药率均较高,其中头孢呋辛的耐药率达71.13%;对替加环素的耐药率最低(3.44%),氨基糖苷类中KPN对阿米卡星耐药率最低(19.53%),KPN对美罗培南、亚胺培南和厄他培南的耐药率分别为14.13%、14.99%和15.97%;对喹诺酮类的耐药率为35.14%~54.55%。结论临床分离KPN菌株较多,对常见抗菌药物的耐药率呈上升趋势,临床工作中应根据药敏试验结果合理选择抗菌药物,最大程度减少多药耐药菌株的产生与传播。OBJECTIVE To investigate the distribution and drug resistance of Klebsiella pneumoniae strains isolated from hospitalized patients so as to provide guidance for clinical prevention and treatment of infection and reasonable use of antibiotics.METHODS The clinical conventional isolates were collected from the First Affiliated Hospital of Xiamen University from Jan 2017 to Dec 2021,the drug susceptibility testing was carried out by disk diffusion method,extended-spectrumβ-lactamases(ESBLs)were determined by disk diffusion method for preliminary screening and enzyme inhibitor enhanced disk method for confirmation,and the data were statistically analyzed by WHONET5.5 and SPSS26.0 software.RESULTS Totally 814 strains of K.pneumoniae were isolated from Jan 2017 to Dec 2021,the isolation rate was the highest in ICU(26.66%).Among the isolated strains,32.80%were isolated from sputum specimens,24.57%from blood specimens,20.64%from urine specimens.The average rate of ESBLs-producing strains was 33.05%in the 5 years,carbapeneme-resistant K.pneumoniae(CRKP)15.11%.The drug resistance rate of K.pneumoniae strains to cephalosporins was high,the drug resistance rate to cefuroxime reached up to 71.13%,the drug resistance rate to tigecycline was the lowest(3.44%).Among the aminoglycosides,the drug resistance rate of the K.pneumoniae strains to amikacin was the lowest(19.53%),the drug resistance rates of the strains to meropenem,imipenem and ertapenem were 14.13%,14.99%and 15.97%,respectively.The drug resistance rates to quinolones ranged between 35.14%and 54.55%.CONCLUSION There are so many clinical isolates of K.pneumoniae,the drug resistance rates of the strains to commonly used antibiotics show upward trends.It is necessary to reasonably used antibiotics based on the result of drug susceptibility testing so as to minimize the occurrence and spread of multidrug-resistant strains.

关 键 词：医院感染 肺炎克雷伯菌 超广谱Β-内酰胺酶 碳青霉烯酶 多药耐药 

分 类 号：R378.996[医药卫生—病原生物学]