近5年肺炎克雷伯菌临床分布特征及耐药现状分析  

Clinical characteristics and antimicrobial resistance analysis of Klebsiella pneumoniae strains in recent 5 years

作　　者：卫明 陈田 杨楷 WEI Ming;CHEN Tian;YANG Kai(Clinical Laboratory,Hubei Provincial Hospital of Integrated Chinese and Western Medicine,Wuhan 430015,China)

机构地区：[1]湖北省中西医结合医院检验科,武汉430015

出　　处：《中南民族大学学报(自然科学版)》2025年第2期178-182,共5页Journal of South-Central Minzu University(Natural Science Edition)

基　　金：国家自然科学基金资助项目(30873104)。

摘　　要：目的:分析湖北省中西医结合医院2018―2022年肺炎克雷伯菌(KP)的临床分布及其耐药性变化.方法:对2018年1月―2022年12月送检标本进行细菌培养鉴定和药物敏感性试验,使用WHONET 5.6、SPSS 22.0软件对标本类型、年龄、科室分布、及抗菌药物耐药结果进行回顾性分析.结果:共分离KP 893株,分离率达15.35%.其中CRKP(耐碳青霉烯类肺炎克雷伯菌) 303株,占比33.93%,期间检出呈现增长趋势(χ^(2)=23.755,P<0.001).标本分离主要来自呼吸道(47.59%)、尿液(21.72%)、脓液(11.65%)、血液(10.64%)等;患者以老年人居多,61~80岁年龄段为主(46.47%),检出患者男性多于女性.科室主要以ICU(21.16%)、神经内科(12.21%)、普通外科(11.76%)、呼吸内科(10.30%)分布为主.通过药敏结果可知,CSKP(碳青霉烯类敏感肺炎克雷伯菌)对大多数抗菌药的耐药率不超过40%,其中复方新诺明耐药率增长趋势明显(P=0.035).CRKP对头孢类药物几乎全耐药,复合型抗生素高水平耐药.对喹诺酮类、氨基糖苷类、复方新诺明耐药率呈现增长趋势(P<0.05),其中环丙沙星、左氧氟沙星耐药率高达100%.结论:肺炎克雷伯菌作为呼吸道感染的重要检出菌,年老病情危重更容易感染.CRKP的检出递增现象,多重耐药甚至全耐药性特点,提示有效治疗需结合药敏规范化操作.通过监测肺炎克雷伯菌的临床分布和耐药性,为临床合理使用抗菌药物及医院感染防控提供参考依据.Objective:To analyze the clinical distribution and antimicrobial resistance changes of Klebsiella pneumoniae(KP)in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from 2018 to 2022.Methods:Bacterial culture identification and drug sensitivity test were performed on samples from January 2018 to December 2022.WHONET 5.6 and SPSS 22.0 software were used to retrospectively analyze the types of samples,age,department distribution and results of antimicrobial resistance.Results:A total of 893 KP strains were isolated,with a separation rate of 15.35%,among which 303 were Carbapenem-resistant Klebsiella pneumoniae(CRKP)strains,accounting for 33.93%and showing an increasing trend(χ^(2)=23.755,P<0.001).The specimens were mainly isolated from respiratory tract(47.59%),urine(21.72%),pus(11.65%),blood(10.64%),etc.Most of the patients were elderly,with the majority aged from 61 to 80 years(46.47%).More male patients were identified than female patients.The departments were mainly ICU(21.16%),neurology(12.21%),general surgery(11.76%)and respiratory medicine(10.30%).According to the results of drug sensitivity,the resistance rate of Carbapenem-sensitive Klebsiella pneumoniae(CSKP)to most antimicrobials was not more than 40%,and the resistance rate of cotrimoxazole increased significantly(P=0.035).CRKP showed almost total drug resistance to cephalosporins and high level drug resistance to compound antibiotics.It demonstrated resistance to quinolones,aminoglycosides and cotrimoxazole,with an increasing trend(P<0.05)and a resistance rate to ciprofloxacin and levofloxacin being as high as 100%.Conclusion:Klebsiella pneumoniae is an important detection bacterium for respiratory infection that the elderly patients with critical illness are more susceptible to infection.The increasing detection of CRKP and the characteristics of multi-drug resistance and even full drug resistance suggest that effective treatment should be combined with standardized drug sensitivity operation.The clinical distribution and drug resi

关 键 词：肺炎克雷伯菌 临床分布 耐药率 感染防控 

分 类 号：R378.99[医药卫生—病原生物学] R969.3[医药卫生—基础医学]