2017—2020年2426株肺炎克雷伯菌临床分布及耐药性变迁回顾性分析

Retrospective analysis on changes in clinical distribution and antimicrobial resistance of 2,426 strains of Klebsiella pneumonia, 2017-2020

目的了解湖南中医药大学第一附属医院肺炎克雷伯菌(Klebsiella pneumoniae,KP)的临床分布和耐药性特征,并对耐碳青霉烯肺炎克雷伯菌(carbapenem resistant Klebsiella pneumoniae,CRKP)的耐药性变迁进行分析,为临床合理选用抗菌药物提供依据。方法回顾性分析2017年1月—2020年12月临床分离KP的标本来源、科室来源,整体药敏试验结果,对不同年度、主要科室来源CRKP分离率及常用抗菌药物的耐药性变迁进行统计学分析。结果2017—2020年共分离非重复KP 2426株,其中1825株(75.23%)来自下呼吸道,246株(10.14%)来自尿液,164株(6.76%)来自全血。呼吸内科、老年病科和中心ICU分离占比居前三位,共分离924株(38.09%)。所有分离株对头孢曲松、亚胺培南、阿米卡星和替加环素的耐药率分别为34.36%、20.02%、7.79%和2.31%。共分离CRKP 500株,2017—2020年分离出CRKP比率分别为23.34%、25.30%、18.52%和13.94%,中心ICU和烧伤创伤整形外科分离出CRKP比率高达61.82%和59.26%。2017—2020年各年度CRKP对阿米卡星的耐药率分别为49.64%、30.36%、31.75%、23.19%,对替加环素耐药率分别为7.30%、7.74%、6.35%和8.70%,CRKP对其余常用抗菌药物均表现为高度耐药。结论该院临床分离的KP主要来自老年和重症患者呼吸道、泌尿系统和血流感染,耐药情况比较严峻。近两年CRKP分离率呈现下降趋势,有待进一步观察。临床应重视CRKP联合治疗方案的应用,院感科应加强对多重耐药KP和抗菌药物的管控,预防院内感染并对CRKP的院内获得性传播引起高度重视。

Objective To understand the clinical distribution and drug resistance characteristics of Klebsiella pneumoniae(KP)in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,to analyze the changes in drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP),and to provide a basis for rational selection of antimicrobial drugs in clinical practice.Methods We retrospectively analyze the specimen source,department source,and overall drug susceptibility test results of the clinically isolated KP from January 2017 to December 2020.The separation rate of CRKP from sources in different years and major departments and the changes in resistance of antibacterial drugs commonly used were statistically analyzed.Results A total of 2,426 non-repetitive KP strains were isolated from 2017 to 2020,of which 1,825(75.23%)were from the lower respiratory tract,246(10.14%)from urine,and 164(6.76%)from whole blood.Department of respiratory medicine,department of geriatrics and central ICU ranked the top three departments from which the strains were isolated,with a total of 924 isolates(38.09%).The drug resistance rates of all isolates to ceftriaxone,imipenem,amikacin and tigecycline were 34.36%,20.02%,7.79%and 2.31%respectively.A total of 500 strains of CRKP were isolated.The separation rates of CRKP for 4 years in 2017-2020 were 23.34%,25.30%,18.52%,and 13.94%respectively.The separation rates of CRKP isolated from central ICU and department of burn,trauma and plastic surgery were as high as 61.82%and 59.26%,respectively.The resistance rates of CRKP to amikacin for 4 years in 2017-2020 were 49.64%,30.36%,31.75%,and 23.19%,respectively,and those to tigecyclinewere 7.30%,7.74%,6.35%and 8.70%,respectively.CRKP was highly resistant to other commonly-used antimicrobial agents.Conclusion KP isolated clinically in the hospital mainly came from the elderly and severe patients with infections of respiratorytract,urinary tract and blood,and the drug resistance was relatively severe.The separation rates of CRKP in 2019 and 2020 showed a downward trend,which needs further observation.It is necessary to pay special attention to the clinical application ofcombined therapy for CRKP infection.Department of nosocomial infection should enhance the regulation of multi-drug resistant KPand antibacterial drugs,prevent hospital-acquired infections,and pay special attention to CRKP nosocimial transmission.