肺炎克雷伯菌在天津市环湖医院的感染现状、分布特点及耐药性分析

The Infection Status, Distribution and Antibiotic Resistance of Klebsiella Pneumoniae in Tianjin Huanhu Hospital

目的为了了解天津市环湖医院2017年1—12月分离的肺炎克雷伯菌的临床分布特征及耐药现状,为指导临床合理用药及控制感染提供依据。方法按照《全国临床检验操作规程》分离细菌,对分离的600株肺炎克雷伯菌的的分布及耐药情况进行回顾性分析。结果 2017年1—12月分离出非重复肺炎克雷伯菌600株,其次为鲍曼不动杆菌307株,大肠埃希菌229株,粘质沙雷菌224株,铜绿假单胞菌212株,肺炎克雷伯菌排名第一。肺炎克雷伯菌在重症医学科(ICU)的检出率最高(19%),其次为颅脑抢救二病区(10%),神经外科七病区(8%)。临床标本主要来源于痰液(92%)、脑脊液(3%),尿液(3%)。产ESBLs的肺炎克雷伯菌有220株,检出阳性率为36.7%。ICU内的肺炎克雷伯菌对大多数药物的耐药性高于全院平均水平。结论临床分离出的致病菌中肺炎克雷伯菌所占的比例最大,对各类抗菌药物呈现不同程度的耐药特点。

Objective To investigate the clinical distribution and antibiotic resistance of Klebsiella pneumoniae isolated from Tianjin Huanhu Hospital from January to December 2017, to provide evidence for clinical rational drug use and infection control. Methods The isolation of bacteria is according to national clinical laboratory operation procedures. The distribution and antibiotic resistance of 600 isolates of K. pneumoniae were retrospectively analyzed. Results From January to December 2017, 600 non-repetitive K. pneumoniae strains were isolated, followed by 307 strainsof Acinetobacter baumannii, 229 strains of Escherichia coli, 224 strains of Serratia marcescens, 212 strains of Pseudomonas aeruginosa, and K. pneumoniae ranked frst. The detection rate of K. pneumoniae in ICU was the highest （19%）, followed by craniocerebral emergency ward 2 （10%） and neurosurgical ward 7 （8%）. K. pneumonia-positive specimens were mostly derived from sputum （92%）, cerebrospinal fluid （3%） and urine （3%）. ESBLs-producing K. Pneumoniae was detected in 36.7% of the 220 isolates. The resistance of K. pneumoniae to most drugs in ICU is higher than the average level. Conclusion Klebsiella pneumoniae accounted for the largest proportion of clinical isolates, showing different degrees of resistance to antibiotics.