2011-2015年某院肺炎克雷伯菌的分布特点及耐药性分析

Analysis on distribution characteristics and drug resistance of Klebsiella pneumoniae in a hospital during 2011-2015

目的探讨2011-2015年海军总医院肺炎克雷伯菌的临床分布情况及耐药性变迁,为临床用药提供参考依据。方法选取海军总医院2011-2015年临床分离出的肺炎克雷伯菌,分析其检出率、科室分布情况、标本来源、抗菌药物耐药性及对碳青霉烯类抗菌药物耐药性的变化趋势。结果 2011-2015年肺炎克雷伯菌的检出株数和分离率呈逐年上升趋势,标本主要来源于重症监护室、高压氧科、呼吸内科、放射肿瘤科、肾脏病科等10个科室,其中高压氧科检出率最高,其次是呼吸内科、重症监护室;送检标本以痰液和尿液为主,分别占送检标本的59.7%和21.4%;2011-2015年肺炎克雷伯菌耐药性呈逐年上升趋势。该菌对哌拉西林、氨苄西林、氨苄西林/舒巴坦和头孢呋辛酯耐药率较高,对阿米卡星、亚胺培南、美罗培南和妥布霉素的耐药率较低;对碳青霉烯类抗菌药物亚胺培南和美罗培南的耐药率逐年不断上升,泛耐药肺炎克雷伯菌呈快速上升趋势。结论肺炎克雷伯菌耐药现象严重,尤其耐碳青霉烯类抗菌药物的肺炎克雷伯菌近年来明显增加,应加强对其耐药性监测,指导临床合理用药。

Objective To investigate the clinical distribution situation and drug resistance change of Klebsiella pneumoniae in the Navy General Hospital during 2011-2015 in order to provide reference for rational use of antibacterial agents in clinic.MethodsThe clinically isolated Klebsiella pneumoniae in this hospital during 2011-2015 were selected and performed the analysis on the detection rate,department distribution,specimens source,resistance of antibacterial drugs and change trend of resistance to carbapenem antibacterial drugs.Results The number the detected Klebsiella pneumoniae strains and isolation rate during 2011-2015 showed an increasing trend year by year,the specimens sources were mainly from 10 departments of intensive care units（ICU）,hyperbaric oxygen department,respiratory department,radiation oncology department,kidney disease department,etc.;the submitted specimens were dominated by sputum and urine,accounting for 59.7% and 21.4% of submitted specimens;the drug resistance of Klebsiella pneumoniae during 2011-2015 showed the increasing trend year by year.Klebsiella pneumoniae had higher resistance rates to piperacillin,ampicillin,ampicillin/sulbactam and cefuroxime and had lower resistance rate to amikacin,imipenem,meropenem and tobramycin;the resistance rates to imipenem and meropenem were increased year by year,and pan-drug resistant Klebsiella pneumoniae showed a rapidly rising trend.Conclusion The drug resistance of Klebsiella pneumonia is serious,especially carbapenems-resistant Klebsiella pneumoniae is significantly increased in the recent years,therefore its drug resistance monitoring should be strengthened for guiding rational drug use in clinic.