湖南省细菌耐药监测网2012—2021年克雷伯菌属细菌的耐药性变迁  

Changes in antimicrobial resistance of Klebsiella spp.,Hunan Province Antimicrobial Resistance Surveillance System,2012-2021

作　　者：豆清娅[1,2] 陈丽华 付陈超[1,2,4] 李晨[5] 李艳明 刘君 宁兴旺[8] 石国民 邬靖敏[10] 杨怀德[11] 袁红霞 郑铭 任南[1,2,4,13] 吴安华 黄勋[1,2,4,13] 任碧琼 DOU Qing-ya;CHEN Li-hua;FU Chen-chao;LI Chen;LI Yan-ming;LIU Jun;NING Xing-wang;SHI Guo-min;WU Jing-min;YANG Huai-de;YUAN Hong-xia;ZHENG Ming;REN Nan;WU An-hua;HUANG Xun;REN Bi-qiong(Center for Healthcare-associated Infection Control,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders,Changsha 410008,China;Department of Laboratory Medicine,The Third Xiangya Hospital of Central South University,Changsha 410013,China;Hunan Province Antimicrobial Resistance Surveillance System Office,Changsha 410008,China;Department of Laboratory Medicine,Liuyang Traditional Chinese Medicine Hospital,Liuyang 410300,China;Department of Laboratory Medicine,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Laboratory Medicine,Xiangtan Central Hospital,Xiangtan 411100,China;Medical Laboratory and Pathology Center,The First Hospital of Hunan University of Chinese Medicine,Changsha 410011,China;Department of Laboratory Medicine,Changsha Central Hospital,Changsha 410004,China;Department of Laboratory Medicine,The First Hospital of Changsha,Changsha 410005,China;Department of Laboratory Medicine,Zhangjiajie People’s Hospital,Zhangjiajie 427000,China;Center for Laboratory Medicine,The First People’s Hospital of Chenzhou,Chenzhou 423000,China;Hunan Provincial Healthcare-associated Infection Management Quality Control Center,Changsha 410008,China;The Second Hunan Provincial People’s Hospital,Changsha 410007,China)

机构地区：[1]中南大学湘雅医院医院感染控制中心,湖南长沙410008 [2]国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008 [3]中南大学湘雅三医院检验科,湖南长沙410013 [4]湖南省细菌耐药监测网办公室,湖南长沙410008 [5]浏阳市中医医院检验科,湖南浏阳410300 [6]中南大学湘雅医院检验科,湖南长沙410008 [7]湘潭市中心医院检验科,湖南湘潭411100 [8]湖南中医药大学第一附属医院医学检验与病理中心,湖南长沙410011 [9]长沙市中心医院检验科,湖南长沙410004 [10]长沙市第一医院检验科,湖南长沙410005 [11]张家界市人民医院检验科,湖南张家界427000 [12]郴州市第一人民医院检验医学中心,湖南郴州423000 [13]湖南省医院感染管理质量控制中心,湖南长沙410008 [14]湖南省第二人民医院(湖南省临床检验质量控制中心),湖南长沙410007

出　　处：《中国感染控制杂志》2024年第4期421-428,共8页Chinese Journal of Infection Control

基　　金：湖南省自然科学基金资助项目(2021JJ40980);“感·动中国”医疗机构感染预防与控制科研项目(GY2023013-A)。

摘　　要：目的了解湖南省克雷伯菌属细菌和儿童患者分离克雷伯菌属细菌的耐药性变化,为该地区医疗机构合理使用抗菌药物提供依据。方法分析湖南省细菌耐药监测网2012—2021年克雷伯菌属细菌的相关数据,根据美国临床实验室标准化协会(CLSI)M100第32版标准对结果进行判断,应用WHONET 5.6软件对结果进行统计分析。结果2012—2021年湖南省细菌耐药监测网共分离361539株克雷伯菌属细菌,其中肺炎克雷伯菌占86.7%,菌株主要来源于呼吸道标本(66.5%)。2015—2021年克雷伯菌属细菌对亚胺培南和美罗培南的耐药率在10%左右;对替加环素的耐药率下降,2012—2013年的耐药率为7.1%,2018—2021年均<4%;对头孢哌酮/舒巴坦的耐药率2012—2021年上升明显,2020—2021年为13.3%。儿童患者分离的克雷伯菌属细菌2015—2021年对碳青霉烯类药物的耐药率为3.5%~8.6%,2012—2021年对替加环素的耐药率均≤3.8%。2020—2021年新生儿、儿童、成人和老年人患者耐碳青霉烯类克雷伯菌属细菌的检出率分别为4.7%、3.9%、9.5%、10.2%。结论2012—2021年克雷伯菌属细菌对碳青霉烯类药物耐药率较低,但出现了对替加环素耐药的菌株,需引起重视,应合理使用抗菌药物,预防和控制医院感染发生。Objective To investigate the change in antimicrobial resistance of all Klebsiella spp.and Klebsiella spp.isolated from pediatric patients in Hunan Province,provide evidence for rational use of antimicrobial agents in the medical institutions in this area.Methods Data about Klebsiella spp.from Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021 were analyzed,and the results were judged according to M10032nd edition standard of American Clinical and Laboratory Standards Institute(CLSI),WHONET 5.6 software was used to statistically analyze the results.Results A total of 361539 Klebsiella spp.strains were isolated from hospitals in Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021,Klebsiella pneumoniae accounted for 86.7%,and strains were mainly from respiratory tract specimens(66.5%).The resistance rate of Klebsiella spp.to imipenem and meropenem were about 10.0%in 2015-2021.The resistance rate to tigecycline decreased,with a resistance rate of 7.1%in 2012-2013 and an annual average resistance rate<4.0%in 2018-2021.The resistance rate of bacteria to cefoperazone/sulbactam increased significantly in 2012-2021,with a rate of 13.3%in 2020-2021.Carbapenems resistance rates of Klebsiella spp.from pediatric patients in 2015-2021 were 3.5%-8.6%,and the resistance rates to tigecycline were all≤3.8%in 2012-2021.The detection rates of carbapenem-resistant Klebsiella spp.in newborns,children aged 29 days-14 years,adults and elderly patients in 2020-2021 were 4.7%,3.9%,9.5%and 10.2%,respectively.Conclusion The resistance rates of Klebsiella spp.to carbapenems were low in 2012-2021,tigecycline-resistant strains have emerged,which should be paid attention to,antimicrobial agents should be used rationally to prevent and control the occurrence of healthcare-associated infection.

关 键 词：克雷伯菌属 肺炎克雷伯菌 碳青霉烯类耐药 耐药性 监测 湖南省细菌耐药监测网 

分 类 号：R181.32[医药卫生—流行病学]