2014—2016年大连地区血流感染肺炎克雷伯菌的耐药性特征分析

Antimicrobial resistance of Klebsiella pneumoniae isolated from bloodstream infection in Dalian from 2014 to 2016

目的分析肺炎克雷伯菌所致血流感染患者的科室分布及其病原菌耐药性特征,为指导临床合理应用抗菌药物,有效控制感染提供依据。方法选择2014-2016年大连医科大学附属第一医院送检血液标本中分离得到的289株肺炎克雷伯菌,对其进行细菌鉴定、药敏试验及ESBL确认试验,分析肺炎克雷伯菌所致血流感染患者的科室分布特征及其病原菌耐药性变迁。结果患者血液中肺炎克雷伯菌检出率以急诊科(24.91%)和ICU为最高(23.88%)。3年中肺炎克雷伯菌对碳青霉烯类抗生素和阿米卡星耐药率较低,均在20.00%左右。产ESBL肺炎克雷伯菌共135株,占46.71%,对常用抗生素的耐药率均显著高于非产ESBL菌株(P<0.01)。碳青霉烯类抗生素耐药菌株对常用抗生素耐药率均高于敏感菌株(P<0.01),对四环素、复方新诺明和阿米卡星耐药率相对较低,分别为66.10%、66.10%、71.19%。结论我院2014-2016年患者血液中肺炎克雷伯菌检出率以急诊科和ICU为最高。该菌对碳青霉烯类抗生素及阿米卡星的耐药率较低,碳青霉烯类抗生素耐药菌株对四环素、复方新诺明和阿米卡星尚有一定敏感性。

Objective To analyze the clinical distribution and drug resistance of K.pneumoniae from bloodstream infection（BSI）,so as to provide evidence for clinical rational use of antibiotics and effective control of the infection.Methods 289 strains of K.pneumoniaeisolated from BSI patients in our hospital from 2014 to 2016 were collected for bacterial identification,antimicrobial susceptibility test and ESBLs phenotype confirmation.The clinical distribution and antibiotic resistance of K.pneumoniaefrom bloodstream infection were analyzed.Results Patients with K.pneumoniae BSI mainly distributed in the emergency department（72/289）and intensive care unit（69/289）.During these 3 years,K.pneumoniaeshowed low resistance rates to Carbapenems and Amikacin,at around 20.00%.A total of 135（46.71%）ESBL producing strains were identified;their resistance rates to commonly used antibiotics were significantly higher than those of non-ESBL producing strains（P〈0.01）.The resistance rates of Carbapenem resistant strains to common antibiotics were higher than those of susceptible strains（P〈0.01）,while their resistance rates to Tetracycline,Sulfamethoxazole and Amikacin were relatively low（66.10%,66.10% and 71.19%,respectively）.Conclusion Klebsiella pneumoniae BSI was mainly found in the emergency department and the intensive care unit in our hospital during 2014 and 2016;the resistance rates of the pathogen to Carbapenem and Amikacin were relatively low.Carbapenem-resistant strains were still relatively sensitive to Tetracycline,Sulfamethoxazole and Amikacin.