2011-2018年临床分离高黏液表型肺炎克雷伯菌临床分布与耐药率研究

Clinical distribution and drug resistance rates of high mucus phenotype Klebsiella pneumoniae strains isolated from 2011 to 2018

目的了解高黏液表型肺炎克雷伯菌分布特点与耐药率变化趋势,为临床提供指导。方法收集2011年1月-2018年12月贵州医科大学第三附属医院临床分离的高黏液表型肺炎克雷伯菌617株,三维试验法检测头孢菌素酶(AmpC),双纸片协同扩散法检测超广谱β-内酰胺酶(Extended Spectrum Beta-Lactamases,ESBLs),细菌学鉴定与最低抑菌浓度(minimum inhibitory concentration,MIC)测定采用Phoenix-100全自动细菌鉴定药敏系统,按照美国临床与实验室标准化协会(CLSI)标准判断结果,并进行统计分析。结果高黏液表型肺炎克雷伯菌占肺炎克雷伯菌12.17%,占肠杆菌科细菌2.76%;对头孢唑林、氨苄西林、氨苄西林/舒巴坦、头孢曲松、阿莫西林/克拉维酸等耐药率均≥20%;其他抗菌药物均<10%;对庆大霉素、环丙沙星、阿米卡星、氧氟沙星、氨苄西林、左氧氟沙星、氨苄西林/舒巴坦、头孢呋辛、哌拉西林/他唑巴坦、头孢哌酮、头孢吡肟、头孢他啶、妥布霉素、氨曲南、米诺环素等耐药率呈逐年上升趋势(P<0.05);ESBLs酶与AmpC酶检出率也逐年上升(P<0.05)。结论高黏液表型肺炎克雷伯菌的ESBLs酶与AmpC酶检出率与耐药率逐年上升,应高度重视产酶菌的监测和控制。

OBJECTIVE To understand the changes of clinical distribution and drug resistance rates of the high mucus phenotype Klebsiella pneumoniae strains so as to provide guidance for clinical practice. METHODS A total of 617 clinical isolates of high mucus phenotype K. pneumoniae were collected from Jan 2011 to Dec 2018.Cephalosporinase(AmpC) was detected by three-dimensional test, extended-spectrum beta-Lactamases(ESBLs) were detected by two-disk synergistic diffusion method, the bacteriological identification was carried out by using Phoenix-100 automatic bacterial identification system, and the minimum inhibitory concentration(MIC) was determined by means of drug susceptibility system, the results were interpreted based on the standards of Clinical and Laboratory Standards Institute(CLSI), and the statistical analysis was performed. RESULTS The high mucus phenotype K. pneumoniae strains accounted for 12.17% among the K. pneumoniae strains and 2.76% among Enterobacteriaceae strains.The drug resistance rates to cefazolin, ampicillin, ampicillin-sulbactam, ceftriaxone and amoxicillin-clavulanic acid were no less than 20%, while the drug resistance rates to other antibiotics were less than 10%;the drug resistance rates to gentamicin, ciprofloxacin, amikacin, oxacillin, ampicillin, levofloxacin, ampicillin-sulbactam, cefuroxime, piperacillin-tazobactam, cefoperazone, cefepime, ceftazidime, tobramycin, aztreonam and minocycline significantly increased year by year(P<0.05).The detection rates of ESBLs and AmpC also significantly increased year by year(P<0.05). CONCLUSION The detection rates of ESBLs and AmpC as well as drug resistance rates of the high mucus phenotype K. pneumoniae strains are increased year by year, and it is necessary to pay great attention to the monitoring and control of the enzyme-producing strains.