2012～2016肺炎克雷伯菌分布及耐药变化趋势分析

Analysis of Klebsiella Pneumoniae Distribution and Drug Resistance Trend During 2012-2016

目的对2012～2016年医院患者肺炎克雷伯菌(KPN)感染现状及耐药性进行调查,为感染监控和临床用药提供参考。方法回顾性分析2012～2016年医院患者细菌培养标本中KPN的分离情况及耐药性的变迁趋势。结果共分离KPN 2043株,逐年总体分离率无明显变化,产ESBLs菌株的分离率2012～2014年逐年下降,而2014～2016年则逐年上升,CRKP的分离率则逐年显著上升,2016年CRKP分离率达42.53%。临床分离的KPN主要来源于痰、全血、尿液、分泌物和引流液标本,2012～2016年痰标本的分离率呈逐年下降趋势,而全血的分离率呈逐年递增趋势。其他标本类型的分离率亦有一定的波动,分离KPN阳性率较高的病区是重症医学科、神经外科、呼吸科、老年病科和肾内科等,除重症医学科的分离率逐年上升外,其余病区无明显变化。碳青霉烯类耐药率逐年显著上升,2016年达42.53%。其余抗菌药物2012～2015年的耐药率有一定的波动,但总体变化不明显,2016年各抗菌药物的耐药率均明显升高。结论我院KPN的耐药趋势有一定的波动,尤其2016年耐药情况较为严重,应引起各相关科室高度重视,临床应根据药物敏感性试验结果合理使用抗菌药物。

Objective To investigate the current status of Klebsiella pneumoniae infection in our hospital from 2012 to 2016 and its drug resistance in order to provide reference for clinical medication. Methods The retrospective analysis was performed on the separation condition and the drug resistance of Klebsiella pneumoniae in the bacterial culture sampled from the inpatients of our hospital from 2012 to 2016. Results A total of 2043 strains of KPN were isolated, with no significant changes for the overall separation rate longitudinally. The isolation rate of ESBLs producing strains decreased during in 2012-2014, while increasing during 2014-2016. The separation rate of CRKP is significantly increased each year with the 2016 CRKP separation rate of 42.53 %. The clinical isolates of KPN was mainly from sputum, blood, urine, secretions and drainage during 2012-2016. For sputum specimens, the separation rate decreased for each year, while the blood separation rate was increasing. The rates of isolation of other types of samples also had certain fluctuation, with high positive rate of isolation of KPN from ICU, department of neurosurgery, department of respiration, department of geriatrics and department of nephrology. The isolation rate of ICU department increased for each year, while other departments has no significant changes. Carbapenem resistance rate was significantly increased, with in 2016 amounted to 42.53 %. The rates of resistant to other antimicrobial agents during 2012-2015 had certain fluctuation, but the overall change was not obvious, while the antimicrobial resistance rates were significantly increased in 2016. Conclusion The trend of drug resistance of KPN in our hospital has certain fluctuations ,especially in 2016 ,with the drug resistance situation was more serious. So the relevant departments should pay great attention to it, and the clinical use of antibiotics should be based on the results of drug sensitivity test.