安徽省809株肺炎克雷伯菌感染的临床分布、耐药性与基因型分析

Distribution,antimicrobial resistance and genotypes of 809 isolates of Klebsiella pneumoniae in Anhui province

目的了解安徽省2013年与2014年肺炎克雷伯菌感染的临床分布及耐药情况,为临床合理使用抗菌药物药供参考依据。方法收集安徽省内35所医院送检的临床标本,从中分离出肺炎克雷伯菌株,采用琼脂倍比稀释法进行抗菌药物敏感性测定,用WHONET 5.6和SPSS l7.0软件对肺炎克雷伯菌的来源、耐药率及其变化情况进行统计分析。结果 2013—2014年共分离出肺炎克雷伯菌809株,其中来源于ICU的标本中的检出率最高,平均检出率为30.7%。绝大部分菌株分离于痰液标本,占总菌株的57.8%。两年的菌株产ESBLs菌株的检出率分别为32.5%和38.9%,多重耐药检出率分别为37.2%和40.9%。药物敏感试验结果显示:在所有进行检测的抗菌药物里,碳青霉烯类药物的耐药率最低;耐药率最高的药物为氨苄西林,分别为55.4%和63.4%。产ESBLs的肺炎克雷伯菌菌株对多种类抗菌药物的耐药率均高于非产ESBLs菌株。282株产ESBLs肺炎克雷伯菌中,97株细菌携带blaCTX-M-14基因。结论临床标本分离出肺炎克雷伯菌株较多,CTX-M-14型超广谱β-内酰胺酶为主要的耐药机制,因此该菌株对临床常用的各类抗菌药物呈现出不同程度的耐药;治疗上可优先选用含酶抑制剂的复合制剂或碳青霉烯类药物。加强细菌的耐药性监测与防控,有利于临床合理使用抗菌药物。

Objective To investigate the distribution and antimicrobial resistance of Klebsiella pneumoniae isolated from patients hospitalized at 35 different hospitals located in Anhui province, E R. China from 2013 to 2014. Methods All strains were isolated from routine clinical specimens. Agar dilution method was used to test the susceptibility of antimicrobials. Dates were analyzed by WHONET 5.5 and SPSS 17.0 software. Results 809 strains were isolated from clinical specimens during 2013-2014. A majority of isolates were isolated from ICU （30.7%）. The K. pneumonia-positive specimens were mostly derived from sputum （57.8%）. The detection rates of ESBLs-producing K. pneumoniae were 32.5% and 38.9% and the rates of multi-drugs resistance were 37.2% and 40.9% in two years, respectively. In this study, it demonstrated that the most sensitive antimicrobial agents against K. pneumonia were carbapenems. Ampicillin demonstrated the highest resistance rates, which was 55.4% in 2013 and 63.4% in 2014, respectively. The resistant rates of ESBLs-producing K. pneumoniae to several of antimicrobial agents were higher than non-ESBLs-producing clinical strains. There were 97 clinical strains carrying blacTx-M-14 in 282 ESBLs-producingK. pneumoniae. Conclusions More and more strains of K. pneumoniae were isolated from clinical samples. A major mechanism of resistance was CTX-M-14-type ESBLs. Therefore, the isolates have displayed high degrees of resistance to various antimicrobial agents. β-lactamase inhibitors compound antimicrobial agents or carbapenems were priority to treatment. The hospitals should strengthen the monitoring programs and take intervention measures in controlling resistance development in order to guide the rational use of antimicrobial agents.