老年患者下呼吸道感染肺炎克雷伯菌耐药性分析

Analysis of drug resistance of Klebsiella pneumoniae in elderly patients with lower respiratory tract infection

目的探讨由肺炎克雷伯菌引起下呼吸道感染的老年患者对常用抗菌药物的耐药性。方法对解放军总医院老年病房于2018年1月-2020年12月送检的下呼吸道样本检出的1340株肺炎克雷伯菌临床分布及耐药率进行分析。结果3年期间老年病房送检样本共分离出1887株肺炎克雷伯菌,其中下呼吸道来源1340株,构成比为71.01%。1340株肺炎克雷伯菌对亚胺培南的耐药率从2018年的53.22%,上升至2020年的82.87%;对头孢他啶和头孢吡肟的耐药率从2018年的57.89%和60.59%,分别上升至2020年的85.22%和84.52%;对左氧氟沙星和环丙沙星的耐药率从2018年的56.14%和57.89%分别上升至2020年的87.72%和88.24%;对阿米卡星的耐药率从2018年的38.60%,下降至2020年的15.28%。结论老年病房内下呼吸道来源肺炎克雷伯菌构成比较高,对临床常用抗菌药物普遍高度耐药,临床需加强抗菌药物的合理应用。

Objective To investigate the antimicrobial resistance of Klebsiella pneumoniae in elderly patients with lower respiratory tract infection.Methods The clinical distribution and drug resistance rate of 1 340 strains of Klebsiella pneumoniae isolated from lower respiratory tract samples of the patients in the Geriatric Ward of General Hospital of Chinese PLA from January 2018 to December 2020 were analyzed retrospectively.Results A total of 1 887 strains of Klebsiella pneumoniae were isolated from the samples of the Geriatric Ward during the three years,of which 1 340 strains were from lower respiratory tract,accounting for 71.01%.The drug resistance rates of 1 340 Klebsiella pneumoniae to imipenem increased from 53.22% in 2018 to82.87% in 2020;The drug resistance rates to ceftazidime and cefepime increased from 57.89% and 60.59% in 2018 to 85.22%and 84.52% in 2020;The drug resistance rate to levofloxacin and ciprofloxacin increased from 56.14% and 57.89% in 2018 to87.72% and 88.24% in 2020;The drug resistance rate to amikacin decreased from 38.60% in 2018 to 15.28% in 2020.Conclusion In the geriatric ward,the composition of Klebsiella pneumoniae from the lower respiratory tract is relatively high,and it is generally highly resistant to clinically used antibacterial drugs.Rational use of antibiotics should be strengthened in clinic.