重症医学科肺炎克雷伯菌耐药率变迁及中外数据库对比  

Changes in antimicrobial resistance rates of Klebsiella pneumoniae in intensive care unit and comparison between Chinese and foreign databases

作　　者：冯诚怿 张丽伟[1] 王洋洋 江淑芳[1] 狄佳[1] 樊金诺 FENG Cheng-yi;ZHANG Li-wei;WANG Yang-yang;JIANG Shu-fang;DI Jia;FAN Jin-nuo(Department of Infection Management,The First People’s Hospital of Changzhou,Changzhou 213000,China;Department of Microbiology,The First People’s Hospital of Changzhou,Changzhou 213000,China;Department of Emergency Medicine,Changzhou Wujin People’s Hospital,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院感染管理处,江苏常州213000 [2]常州市第一人民医院微生物室,江苏常州213000 [3]常州市武进人民医院急诊内科,江苏常州213000

出　　处：《中国感染控制杂志》2024年第10期1241-1248,共8页Chinese Journal of Infection Control

基　　金：常州市卫健委科技项目(QN202355)。

摘　　要：目的对比常州市第一人民医院重症医学科(简称CZFPH-ICU)和美国重症监护医疗信息库第Ⅳ版(MIMIC-Ⅳ)中肺炎克雷伯菌(KP)检出情况和耐药率,以及CZFPH-ICU中KP耐药率、耐碳青霉烯类肺炎克雷伯菌(CRKP)检出率的变迁。方法回顾性分析2017-2019年CZFPH-ICU与MIMIC-Ⅳ中检出KP的标本分布和耐药率差异,以及2017-2023年CZFPH-ICU KP标本分布、耐药率,不同标本来源的KP、CRKP检出率的变化趋势。结果2017-2019年CZFPH-ICU共检出KP 2434株,以痰标本为主;MIMIC-Ⅳ数据库中共检出KP 1137株,以尿标本为主。与MIMIC-Ⅳ相比,CZFPH-ICU中检出的KP对常用抗菌药物均呈现出更高的耐药率。2020-2023年CZFPH-ICU共检出KP 4874株,仍以痰标本为主,且痰、尿、引流液和胆汁标本中CRKP的检出分别从2017-2019年的17.77%、20.15%、24.22%、24.07%,下降至2020-2023年的12.99%、13.56%、13.63%、8.00%(均P<0.05)。2017-2023年CZFPH-ICU分离的KP对哌拉西林/他唑巴坦、亚胺培南、美罗培南等常用抗生素的耐药率变化趋势为2017-2019年呈现上升,2020-2022年出现下降,2023年略有回升。2023年CZFPH-ICU分离的KP对头孢他啶/阿维巴坦、多黏菌素B及替加环素的耐药率分别为21.28%、10.22%、7.03%。结论近7年CZFPH-ICU中KP耐药率存在缓慢下降趋势,但仍高于国外MIMIC-Ⅳ数据库中KP的耐药率。医院应加强各项感染防控措施,有效控制KP耐药和感染。Objective To compare the detection rates and antimicrobial resistance rates of Klebsiella pneumoniae(KP)between the intensive care unit of The First People’s Hospital of Changzhou(CZFPH-ICU)and the American Medical Information Mart for Intensive Care-IV(MIMIC-Ⅳ),as well as the changes in the antimicrobial resistance rate of KP and detection rate of carbapenem-resistant KP(CRKP)in CZFPH-ICU.Methods Differences in specimen distribution and antimicrobial resistance rate of KP detected from CZFPH-ICU and MIMIC-Ⅳfrom 2017 to 2019,as well as the changing trends of specimen distribution,antimicrobial resistance rate,detection rates of KP and CRKP from different specimen sources in CZFPH-ICU from 2017 to 2023 were retrospectively analyzed.Results A total of 2434 strains of KP were detected in CZFPH-ICU from 2017 to 2019,mainly from sputum specimens.A total of 1137 strains of KP were detected from MIMIC-Ⅳdatabase,mainly from urine specimens.Compared with MIMIC-Ⅳ,KP detected from CZFPH-ICU showed higher resistance rate to commonly used antimicrobial agents.A total of 4874 strains of KP were detected from CZFPH-ICU from 2020 to 2023,mainly from sputum specimens.The detection rates of CRKP from sputum,urine,drainage fluid and bile specimens decreased from 17.77%,20.15%,24.22%and 24.07%in 2017-2019 to 12.99%,13.56%,13.63%and 8.00%in 2020-2023,respectively(all P<0.05).The changing trend of resistance rate of KP isolated from CZFPH-ICU from 2017 to 2023 to commonly used antimicrobial agents such as piperacillin/tazobactam,imipenem,and meropenem increased in 2017-2019,decreased in 2020-2022,and slightly increased in 2023.In 2013,the resistance rates of KP isolated from CZFPH-ICU to ceftazidime/avibactam,polycolistin B and tigacycline were 21.28%,10.22%and 7.03%,respectively.Conclusion In recent 7 years,resistance rate of KP from CZFPH-ICU showed a slow decline trend,but it was still higher than that in foreign MIMIC-Ⅳdatabase.Hospitals should strengthen various infection prevention and control measures to effectively

关 键 词：肺炎克雷伯菌 MIMIC-Ⅳ数据库 重症医学科 标本分布 耐药率变迁 

分 类 号：R181.32[医药卫生—流行病学]