2011年-2017年上海岳阳医院住院患者肺炎克雷伯菌耐药趋势

The antibiotic-resistant trend of Klebsiella pneumoniae isolates from inpatients during 2011-2017

目的分析2011年-2017年上海中医药大学附属岳阳中西医结合医院住院患者肺炎克雷伯菌耐药性及变化趋势,为临床合理应用抗菌药物提供依据。方法对2011 年- 2017年住院患者的临床感染标本进行病原菌培养分离和鉴定,采用VITEK 2 Compact 60全自动分析仪与K-B法进行菌种鉴定和药物敏感性试验,药敏结果按CLSI2017年标准判读,统计肺炎克雷伯菌的耐药性情况。结果共有2271株肺炎克雷伯菌株纳人抗菌药物耐药性回顾分析,除替加环素外,头孢吡肟2014年开始、其他21种抗菌药物2013年开始耐药率都呈现逐年上升趋势(r≥0.75,P<0.05),其中9种抗菌药物的耐药率>30%;643株菌株产ESBIs,产酶率为28.31%;478株菌株符合耐碳青霉烯类菌株定义的标准,CRKP菌株检出率为21.05%,且呈逐年明显上升趋势(r^2 =0.97,P<0.05)。结论肺炎克雷伯菌对常用抗菌药物的耐药性比较严重,细菌产ESBLs的检出率较高,尤其CRKP菌株检出率呈明显逐年上升趋势,需引起注意。

Objective To investigate the antibiotic resistant profile of Klebsiella pneumoniae ( K. pneumoniae ) isolates from inpatients in Y ueyang Hospital of Integrated Traditional Chinese and W estern Medicine during 2011-2017, so as to provide basis for rational use of antimicrobial agents in clinic. Methods Specimens from infected inpatients in Yueyang Hospital from 2011 to 2017 received pathogenic culture,isolation and identification. K. pneumoniae isolates were conducted for the suscepti- bility test to antimicrobial agents using automated systems and Kirby-Bauer method, and the testing results were interpreted according to the CLSI2017. The drug resistance of K. pneumoniae were conducted for statistical analysis. Results Totally 2 271 strains of K. pneumoniae were retrospectively analyzed. With the exception of tigecycline, the trends of antibiotic-resistant rates of 22 antimicrobial agents showed significantly ascending trends year by year (r^2 ≥0. 75),including cefepime since 2014 and the other 21 antimicrobial agents since 2013. The total resistant rates of 9 antimicrobial agents were above 30%. 643 strains were extended-spectrum beta-lactamases ( ESBLs)-producing isolates, and the overall prevalence of ESBLs-producing was 28. 31%;478 strains met the definition of carbapenem-resistant Klebsiella pneumonia ( CRKP), and the total detection rate of CRKP was 21. 05% and showed a significantly rising trend (r^2=0.97, P<0. 05). Conclusion K. pneumoniae is highly resistant to common antimicrobial agents,, and the detection rate of ESBLs-producing strains remains high. Especially, the isolation rate of CRKP isolations showed a significantly increasing tendency,which needs great attention.