2014-2016年广西地区克雷伯菌属细菌耐药性监测

Surveillance of antimicrobial resistance of Klebsiella strains in Guangxi Zhuang Autonomous Region during 2014-2016

目的了解2014-2016年广西地区主要医院临床分离的克雷伯菌属细菌的耐药监测结果。方法收集2014年1月-2016年12月广西细菌耐药性监测网中43所医院(其中三级医院40所、二级医院3所)临床分离的所有克雷伯菌属细菌40 508株,采用纸片扩散法或自动化仪器法按统一方案进行药物敏感性试验。结果克雷伯菌属细菌40 508株包括肺炎克雷伯菌37 419株、产酸克雷伯菌1 724株、鼻硬结克雷伯菌1 059株、肺炎克雷伯菌臭鼻亚种277株、其他29株。2014-2016年克雷伯菌属细菌的检出率分别为15.97%(11 794/73 868)、16.35%(13 982/85 503)和14.34%(14 732/102 752)。克雷伯菌属细菌主要分离自痰液标本。2014-2016年产超广谱β-内酰胺酶(extended-spectrum β-lactamase,ESBLs)肺炎克雷伯菌和产酸克雷伯菌的检出率分别为35.40%(2 912/8 226)、38.50%(3 136/8 145)、35.10%(3 337/9 507)。监测期间,克雷伯菌属细菌除对头孢噻肟、头孢哌酮/舒巴坦、美罗培南耐药率无明显波动外,对绝大多数抗菌药物的耐药率呈逐年上升趋势(P<0.05)。产ESBLs菌株对替加环素、亚胺培南和美罗培南三年间的总耐药率较低,分别为2.48%、3.58%和3.10%。碳青霉烯类敏感的克雷伯菌属细菌对哌拉西林、磺胺甲噁唑/甲氧苄啶耐药率较高。碳青霉烯类耐药的菌株对多数抗菌药物耐药率>30%,对亚胺培南、美罗培南的总耐药率分别为88.37%、83.46%。结论本地区临床分离的克雷伯菌属细菌对绝大多数抗菌药物的耐药率呈逐年上升趋势,其中产ESBLs株对替加环素、亚胺培南和美罗培南较敏感,碳青霉烯类耐药的克雷伯菌属细菌对多数抗菌药物的耐药率较高。临床应谨慎选择碳青霉烯类药物的适应证,延缓细菌耐药性产生。

OBJECTIVE To investigate the surveillance of Klebsiella strains isolated from multiple hospitals in Guangxi Zhuang Autonomous Region during 2014-2016.METHODS A total of 40 508 Klebsiella strains clinically isolated from 43 hospitals（including 40 Grad Ⅲ hospitals and 3 Grade Ⅱ hospitals）in Guangxi bacterial drug-resistance surveillance network during Jan. 2014-Dec. 2016 were collected.Kirby-Bauer method or automated systems was employed to study the antimicrobial susceptibility.The data were analyzed according to CLSI 2014 breakpoints.RESULTS The 40 508 Klebsiellastrains were composed of K.pneumoniae（37 419 strains）,K.oxytoca（1 724）,Klebsiella pneumoniae rhinoscieromatis（1 059）,Klebsiella pneumoniae subsp.Ozaenae（277）and other Klebsiella species（29）.Between 2014 and 2016,the detection rates of Klebsiellaisolates were 15.97%（11 794/73 868）,16.35%（13 982/85 503）and 14.34%（14 732/102 752）,respectively.Most of Klebsiella spp.were isolated from sputum specimens.In 2014-2016,the detection rates of extended-spectrumβ-lactamase producing K.pneumoniae and K.oxytocaisolates were 35.40%（2 912/8 226）,38.50%（3 136/8 145）,and 35.10%（3 337/9 507）,respectively.The resistance rate of Klebsiella bacteria to most antimicrobial drugs was increasing annually（P〈0.05）except that the resistance rates of cefotaxime,cefoperazone sulbactam and meropenem had no obvious fluctuation.The resistance of ESBLs（＋）strains to tigecycline（2.48%）,imipenem（3.58%）and meropenem（3.10%）was relatively low.The sensitive strains of carbapenem also had high sensitivity to piperacillin and compound methoxazole.However,the resistance rates of carbapenem-resistant strains against most of antimicrobial agents tested were higher than 30%.In 2014-2016,the total drug resistance rate of carbapene-resistant Klebsiella strains was 88.37% and 83.46%,respectively.CONCLUSIONThe resistance rate of Klebsiellato most antibacterial drugs is increasing year by year.The ESBLs producing strains are relatively sensitive to tegecycline,imipenem and meropenem.Carbapenem-resistant Klebsiella strains have relatively high drug resistance to most antibacterial drugs.Clinically,the indications of carbapenem agents should be carefully selected to reduce or delay the emergence of bacterial resistance.