2018-2022年长沙某医院结核病患者肺炎克雷伯菌感染的临床分布及耐药性分析  

Clinical distribution and drug resistance analysis of Klebsiella pneumoniae infection from tuberculosis patients of a hospital in Changsha from 2018 to 2022

作　　者：税剑 潘建华[1,2] 向延根 石国民[1,2] 罗莉 Shui Jian;Pan Jianhua;Xiang Yangen;Shi Guomin;Luo Li(Clinical Laboratory,Changsha Central Hospital,Changsha 410004;Clinical Laboratory,The Affiliated Changsha Central Hospital,University of South China,Changsha 410004)

机构地区：[1]长沙市中心医院检验科,长沙410004 [2]南华大学附属长沙中心医院检验科,长沙410004

出　　处：《中国抗生素杂志》2024年第5期593-599,共7页Chinese Journal of Antibiotics

基　　金：湖南省自然科学基金(No.2021JJ40624);湖南省卫生健康委科研计划项目(No.D202311006014,No.202111000032);长沙市科技计划项目(No.kq2004166)。

摘　　要：目的探讨长沙市中心医院结核病患者肺炎克雷伯菌感染的耐药性变化情况,为临床合理使用抗生素提供科学依据。方法WHONET5.6软件统计分析2018年—2022年长沙市中心医院结核病患者肺炎克雷伯菌感染的标本来源以及耐药率,采用SPSS21.0软件比较分析结核普通病房患者与结核重症病房患者肺炎克雷伯菌的耐药性差异。结果2018—2022年长沙市中心医院结核病患者送检标本的肺炎克雷伯菌检出率分别为19.6%(275/1402)、22.6%(316/1400)、25.5%(395/1545)、26.7%(377/1410)和27.7%(368/1329),5年检出率之间的差异有统计学意义(χ^(2)=33.026,P=0),有逐年升高趋势(χ^(2)趋势=30.973,P=0)。2018—2022年结核病患者检出的肺炎克雷伯菌主要来源于痰液(76.6%),其次分别为支气管肺泡灌洗液(10.7%)、尿液(10.1%)。2018—2022年结核病患者所感染的肺炎克雷伯菌对多黏菌素B、替加环素、阿米卡星、妥布霉素、酶抑制剂复合剂、碳青霉烯类抗生素的耐药率较低,对头孢类、喹诺酮类、氨基糖苷类、四环素类、单环类和磺胺类等抗生素耐药率较高。5年间,检出的肺炎克雷伯菌对左氧氟沙星、头孢吡肟、米诺环素、替加环素和多黏菌素B的耐药率变化较为明显(P均<0.05)。受检的抗生素中除多黏菌素B、头孢哌酮/舒巴坦外,2019年各抗生素耐药率出现明显的升高,但到2020年后出现回落并保持平稳波动。5年间结核普通病房患者检出的肺炎克雷伯菌对被检抗生素(多黏菌素B除外)的平均耐药率低于结核重症病房患者,差异具有统计学意义(P均<0.05)。2018—2022年结核病患者CR-KP检出率分别为11.3%(31/275)、14.9%(47/316)、12.2%(48/395)、15.9%(60/377)、11.4%(42/368),5年间CR-KP检出率差异不显著(P>0.05),CR-KP仅对多黏菌素B保持较高的敏感性,耐药率低于5%,而对其他抗生素呈现出不同程度的耐药。结论长沙市中心医院结核病患者送检标本的肺炎�Objective To investigate the change in drug resistance of Klebsiella pneumoniae detected in the tuberculosis patients of Changsha Central Hospital so as to provide a scientific basis for the rational use of antibiotics in clinical practice.Methods WHONET5.6 software was used to statistically analyze the sample source and drug resistance rate of Klebsiella pneumoniae detected in the tuberculosis patients of Changsha Central Hospital from 2018 to 2022,and SPSS21.0 software was used to compare and analyze the difference in drug resistance of Klebsiella pneumoniae between tuberculosis patients in general wards and tuberculosis patients in the intensive care unit.Results The detection rates of Klebsiella pneumoniae in samples submitted by tuberculosis patients in Changsha Central Hospital from 2018 to 2022 were 19.6%(275/1402),22.6%(316/1400),25.5%(395/1545),26.7%(377/1410),and 27.7%(368/1329),respectively.The difference between the detection rates in five years was statistically significant(χ^(2)=33.026,P=0),with an increasing trend year by year(χ^(2)Trend=30.973,P=0).From 2018 to 2022,Klebsiella pneumoniae detected in tuberculosis wards mainly came from sputum(76.6%),followed by bronchoalveolar lavage fluid(10.7%) and urine(10.1%).From 2018 to 2022,the drug resistance rate of Klebsiella pneumoniae in the tuberculosis patients to polymyxin B,tegacycline,amikacin,tobramycin,enzyme inhibitor complex,and carbapenems was low,and the drug resistance rate to cephalosporins,quinolones,aminoglycosides,tetracyclines,monocyclines,sulfonamides and other antibiotics was high.In the past five years,the drug resistance rate of Klebsiella pneumoniae to levofloxacin,cefepime,minocycline,tegacyclin and polymyxin B has changed significantly(P<0.05).Among the antibiotics tested,except polymyxin B and cefoperazone/sulbactam,the drug resistance rate of each antibiotic increased significantly in 2019,but declined and remained stable after 2020.The average resistance rate of Klebsiella pneumoniae detected in patients from the tuberculosi

关 键 词：结核病患者 肺炎克雷伯菌 感染 耐药性 

分 类 号：R978.1[医药卫生—药品]