2013至2017年血流感染肺炎克雷伯菌分布及耐药性

Distribution and drug resistance of Klebsiella pneumoniae in bloodstream infection from 2013 to 2017

目的:分析肺炎克雷伯菌所致血流感染(bloodstreaminfections,BSI)患者的科室分布及其耐药性特征,为临床医生合理用药提供实验室依据。方法:回顾性分析2013年1月至2017年12月期间徐州医科大学附属医院(简称"我院")肺炎克雷伯菌致BSI病例的临床资料,对其耐药变化趋势,以及产超广谱β内酰胺酶(extendedspectrumβ-lactamase,ESBL)和碳青霉烯酶的特点进行分析。结果:患者血液中检出肺炎克雷伯菌共332株,主要来源于重症医学ICU(21%)、急诊I C U (1 8%)和感染病科(8%)。5年中肺炎克雷伯菌对阿米卡星和碳青霉烯类抗菌药物耐药率较低,分别为20%和30%。产ESBL菌株137株,占42.55%,对常用抗菌药物的耐药率显著高于非产ESBL菌株(P<0.01)。碳青霉烯类耐药菌株99株,占27.4%,对常用抗菌药物的耐药率均高于敏感株(P<0.01),对四环素、妥布霉素、阿米卡星和复方新诺明耐药率较低,分别为26.3%,68%,37.4%和57.1%。结论:我院2013至2017年患者血液中肺炎克雷伯菌检出率以重症医学ICU、急诊ICU和感染病科为最高。BSI的肺炎克雷伯菌对碳青霉烯类抗菌药物及阿米卡星的耐药率较低,碳青霉烯类抗菌药物耐药的菌株对四环素、妥布霉素、阿米卡星和复方新诺明尚有一定敏感性。

Objective: To analyze the clinical distribution and antimicrobial resistance of bloodstream infections (BSI) caused by Klebsiella pneumoniae, so as to provide evidence for clinical empirical use of antibiotics. Methods: Data of 332 Klebsiella pneumoniae isolates from BSI patients in Xuzhou Medical University Affiliated Hospital from January 2013 to December 2017 was analyzed retrospectively, including patients’ clinical data, antimicrobial susceptibility test, ESBLs phenotype confirmation as well as drug resistance phenotype of carbapenem. Results: A total of 332 strains of Klebsiella pneumoniae were isolated from the blood of patients, mainly from ICU (21%), EICU(18%) and infectious disease department (8%). The antibiotic resistance rate of Klebsiella pneumoniae to amikacin and carbapenems was relatively low in 5 years (20% and 30%, respectively);137 ESBL-producing strains were isolated, accounting for 42.55%,whose drug resistance rate of common antibacterial drugs was significantly higher than that of non-ESBLproducting strains (P<0.01). Carbapenem-resistant strains isolated were 99 strains, accounting for 27.4%. The drug resistance rate of common antimicrobial strains was higher than that of Carbapenem-sensitive strains (P<0.01). The drug resistance rate of tetracycline, tobramycin, amikacin and compound xinomin was lower, 26.3%, 68%, 37.4% and 57.1%, respectively. Conclusion: Klebsiella pneumoniae BSI was mainly found in the ICU, EICU and infectious diseases department in this hospital during 2013 and 2017, the resistant rate of which to carbapenem and amikacin were relatively low. Carbapenem-resistant strains were still relatively sensitive to tetracycline, tobramycin, amikacin and sulfamethoxazole.