肺炎克雷伯菌临床分布特征及耐药性变迁

Distribution and antibiotic resistance of Clinically Isolated Klebsiella pneumoniae

目的了解本单位近4年临床分离肺炎克雷伯菌分布特征及其对常用抗菌药物的耐药变迁规律。方法回顾性分析本院2013年-2016年临床分离非重复肺炎克雷伯菌;采用纸片扩散法或自动化仪器法进行药物敏感性试验;WHONET 5.6软件进行数据分析。结果 4年共收集非重复肺炎克雷伯菌1919株,标本来源以痰液为主(45.6%),其次为血液(14.6%)。科室分布以内科病房为主(约45.0%),且ICU分离率逐年增多,其分离的肺炎克雷伯菌对常用抗菌药物耐药率明显高于非ICU。近4年耐药率上升幅度大于10.0%的抗菌药物有哌拉西林/他唑巴坦、头孢吡肟、头孢替坦、氨曲南、亚胺培南、环丙沙星、左氧氟沙星、磺胺甲噁唑,其中尤其对亚胺培南的耐药率上升明显,分别为10.5%、13.6%、13.8%和22.5%,同时对亚胺培南年平均MIC值呈现右移趋势。结论肺炎克雷伯菌的临床分离率逐年增加,呼吸道及血流为其主要感染部位,对常用抗菌药物耐药率均呈逐年增长趋势,尤其是对亚胺培南的耐药率近2年增长明显,感染控制部门应引起高度重视,进行流行病学调查并加强耐药性监测。

Objective To investigate the distribution and antibiotic resistance of clinically isolatesed K. pneumoniae in our hospital in recent 4 years. Methods Retrospective investigation method was used to analyze non-duplicated clinically isolatesed K. pneumoniae from 2013 to 2016. Antimicrobial susceptibility was carried out according to Kirby-Bauer method or automated systems. The data was analyzed by using WHONET 5.6 software. Results A total of 1919 non-duplicated clinical isolated K.pneumoniae,of which mainly came from sputum（45.6%） and blood（14.6%）,The highest rate is medical ward about Distribution of departments（45.0%）,and the separation rate of K. pneumoniae in ICU has risen over the increasing（with higher resistance rates than non-ICU isolate）. The resistance rate of antibiotics increased more than 10% were piperacillin/tazobactam,cefepime,cefotetan,aztreonam,imipenem,ciprofloxacin,levofloxacin,sulfamethoxazole in recent 4 years. Especially,the resistance rate of imipenem in K. pneumoniaeas increased significantly（10.5%,13.6%,13.8% and 22.5%）,as well as the annual average MIC of imipenem showed a trend to right. Conclusion Clinical isolates of K. pneumoniae had displayed high degrees of detection. The respiratory tract and blood flow is the main site of infection,and the resistance rate in common antibiotics had risen over the increasing. Especially,the resistance rate of imipenem increased significantly in recent 2 years. Infection control department should pay great attention to,and actively take effective measures to proceed Epidemiological investigation and strengthen the monitoring of drug resistance.