2010-2019年血流感染肺炎克雷伯菌耐药变迁及碳青霉烯耐药基因检测

Changes of drug resistance of Klebsiella pneumoniae and detection of carbapenem resistance gene in bloodstream infection paitents from 2010 to 2019

目的分析2010年至2019年全院血流感染肺炎克雷伯菌对常用抗生素耐药变迁及碳青霉烯耐药肺炎克雷伯菌(CRKP)碳青霉烯耐药基因分布情况。方法收集2010年至2019年临床血流感染的肺炎克雷伯菌,动态分析耐药性变化趋势,用GeneXpert Carba-R全自动病原体快速检测系统检测CRKP碳青霉烯耐药基因。结果共分离非重复肺炎克雷伯菌572株,主要分离自消化科、血液科、急诊科等几个主要科室,其中CRKP菌株共检出81株(14.16%)。10年间该菌对头孢菌素、阿米卡星、复方新诺明等药物耐药率呈上升的趋势;对喹诺酮类、碳青霉烯类药物耐药率近年来上升明显。耐药基因以携带blaNDM基因(68株)为主,blaKPC、blaOXA-48均有检出,未检出blaIMP-1及blaVIM基因。结论我院10年间血流感染肺炎克雷伯菌有较高分离率,且对多种抗生素耐药率增加明显,应引起临床及医院感控工作的高度重视。

Objective To analyze the drug resistance and carbapenem resistance genes distribution of Klebsiella pneumoniae in bloodstream infection from 2010 to 2019.Methods The clinical isolates of Klebsiella pneumoniae with bloodstream infections were collected in 2010-2019.The dynamics of drug resistance trends in the last decade were analyzed.The carbapenemases gene was detected by GeneXpert Carba-R automatic pathogen detection system for carbapenem-resistance Klebsiella pneumoniae(CRKP).Results A total of 572 Klebsiella pneumoniae strains mainly separated from the digestive department,hematology department,emergency department and other major departments were isolated.And 81 strains of CRKP were detected(14.16%).The drug resistance rates to cephalosporin,amikacin,trimoxazole and other drugs showed an increasing trend in the past ten years.Drug resistance to quinolone and carbapenems has increased significantly in recent years.Drug resistance genes were mainly blaNDM(68 strains),blaKPC and blaOXA-48,but no blaIMP-1 and blaVIM were detected.Conclusion Klebsiella pneumoniae had a high separation rate during 10 years in our hospital,and the drug resistance rate increased significantly.We should attach great importance to the work of clinical and hospital infection control.