2016-2018年住院患者泌尿道分离肺炎克雷伯菌的耐药性及趋势分析

Analysis of drug resistance and trend of Klebsiella pneumoniae isolated from urinary tract of inpatients from 2016 to 2018

目的了解住院患者泌尿道分离肺炎克雷伯菌(KP)的临床分布、耐药性及趋势。方法收集2016-2018年某院住院患者泌尿道分离的菌株,并对泌尿道KP分离率及科室、年龄、性别、年度间的药敏结果进行统计分析。结果2016-2018年泌尿道KP的分离率分别为6.06%、9.49%和12.13%,检出率有显著性差异(χ^2=38.324,P<0.001)。检出率占前3位的是泌尿科(15.96%)、神经内科重症监护室(19.15%)和康复科(23.83%),康复科β-内酰胺酶抑制剂复合制剂、喹诺酮类、头孢类抗菌药物耐药率最高。61~70岁组KP检出率最高(30.43%),也是β-内酰胺酶抑制剂复合制剂、头孢类抗菌药物耐药率最高的年龄组。分离自男性泌尿道的KP对抗菌药物的耐药率均高于分离自女性泌尿道的KP。2016年、2017年、2018年产ESBLs菌株检出率分别为35.58%、30.07%、44.44%,差异具有统计学意义(χ^2=6.251,P=0.044)。结论泌尿道分离KP逐年升高,耐药率呈上升趋势,不同人群存在差别,临床应个体化经验性应用抗菌药物。

Objective To understand the clinical distribution,drug resistance and trend of Klebsiella pneumoniae(KP)isolated from urinary tract of inpatients.Methods The strains isolated from urinary tract of inpatients in our hospital from2016 to 2018 were collected,and the isolation rate of urinary tract KP,departments,ages,genders,and results of annual drug sensitivity were statistically analyzed.Results The isolation rates of urinary tract KP were 6.06%,9.49%and 12.13%in2016,2017 and 2018,respectively,and the differences were statistically significant(χ^2=38.324,P<0.001).The top three detection rates of departments were urology department(15.96%),neurology intensive care unit(19.15%),and rehabilitation department(23.83%).The drug resistance rates ofβ-lactamase inhibitor complex,quinolone and cephalosporin in rehabilitation department were the highest.The detection rate of KP was the highest in the group of 61-70 years old(30.43%),which was also the age group with the highest drug resistance rate ofβ-lactamase inhibitor complex and cephalosporin.The antibiotic resistance rate of KP isolated from male urinary tract was higher than that from female urinary tract.The detection rates of ESBLs-producing strains in 2016,2017 and 2018 were 35.58%,30.07%and 44.44%,respectively,and the differences were statistically significant(χ^2=6.251,P=0.044).Conclusion The KP isolated from urinary tract is gradually increasing year by year,and the drug resistance rate is also increasing.There are differences among different populations.The clinical application of antibiotics should be individualized and empirical.