2013年至2015年1830株肺炎克雷伯菌感染的临床分布及耐药性分析

Distribution and antimicrobial resistance profiles of 1830 isolates of Klebsiella pneumoniae from 2013 to 2015

目的分析肺炎克雷伯菌的临床分布和耐药谱变化。方法收集2013年1月至2015年12月温州医科大学附属第一医院临床各种标本分离的1830株肺炎克雷伯菌,用VITEK-2全自动微生物鉴定仪进行菌种鉴定/药敏试验和肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)表型筛查试验,用SPSS 19.0进行统计分析。结果肺炎克雷伯菌引起的感染多发于秋、冬季节,中老年患者(≥46岁)为易感人群。1830株肺炎克雷伯菌在2013年至2015年各年度革兰氏阴性菌中的平均比例为16.76%,主要分离自重症监护室(占30.87%),以痰液标本为主(占46.45%);产ESBLs株阳性检出率及耐亚胺培南菌株检出率分别为34.59%和9.84%。肺炎克雷伯菌对氨苄西林/舒巴坦的耐药率高达41.91%,对第3,4代头孢的耐药率在9.78%~31.58%内波动,对厄他培南和亚胺培南的耐药率均为9.84%,对头孢哌酮/舒巴坦的耐药率为24.32%,对氨曲南、阿米卡星、和复方新诺明的耐药率分别为22.90%,9.29%和26.28%。结论肺炎克雷伯菌的临床分离率高,耐药情况严重,应加强预防及监测。

Objective To investigate the distribution and antimicrobial resistance profiles of KlebsieUa pneumoniae clinical isolates from the various specimens of patients at the first affiliated hospital of Wenzhou medical university and provide the evidence to prevent hospital - acquired infection using reasonably antimicrobial agents. Methods A total of 1830 Klebsiella pneumoniae isolates were isolated from various specimens of patients at the first affiliated hospital of Wenzhou medical university from January 2013 to December 2015. The distribution and antimicrobial resistance were analyzed by SPSS 19.0 software. Results Infections caused by Klebsiella pneumoniae mostly occurred in autumn and winter, and the elderly patients （ 1〉 46 years ） were prone to suffer Klebsiella pneumoniae infections. The KlebsieUa pneumoniae isolates accounted for 16. 76% of Gram - negative bacteria during investigation period. The majority of Klebsiellae pneumoniae were isolated from intensive care unites, accounting for 30. 87%, and were mainly isolated from sputum. The po-sitive rates of extended spectrum beta - lactamases （ESBLs） - producing and imipenem - resistant isolates were 34.59% and 9.84%, respectively. The resistance rates of Klebsiella pneumoniae often usedantimicrobial agents were as follows： the resistance rates of ampicillin/sulbactam, ertapenem and imipenem were 41.91% ,9. 84% and 9. 84%, respectively. The resistance rates of the third and fourth generation cephalosporins ranged from 9.78% to 31.58%. The resistant rates of cefoperazone/sulbactam, aztreonam, amikacin, and sulfame- thoxazole were 24. 32% , 22.90% i 9： 29% and 26.28%, respectively. Conclusion The resistance rates of Klebsiella pneumoniae to clinically often -used antimicrobial agents were high. Therefore, it is necessary to monitor the shift of antimicrobial resistance among Klebsiella pneumoniae clinical isolates.