2018年~2019年杭州某医院肺炎克雷伯菌耐药性分析

Analysis of the Resistance of Klebsiella Pneumoniae in a Hospital in Hangzhou from 2018 to 2019

目的回顾性分析某医院肺炎克雷伯菌的耐药现状,为临床治疗提供指导建议。方法收集某三甲医院2018年~2019年784株肺炎克雷伯菌,统计标本来源,采用VITEK^(■)2Compact全自动微生物分析仪对菌株进行鉴定和药敏试验,手工药敏试验采用K-B法,分析该院肺炎克雷伯菌耐药情况。结果784株肺炎克雷伯菌主要来源于痰液标本(50.51%)、其次是血液标本(15.22%)、尿液标本(13.91%),其他标本包括伤口、胆汁、排泄物、腹腔引流液、留置管和脓肿等(20.36%);2018年~2019年该院肺炎克雷伯菌总体耐药情况呈缓慢上升趋势;头孢菌素类药物中,对头孢唑林(46.82%)和头孢曲松(44.15%)耐药率较高,对头孢他啶(32.75%)、头孢吡肟(27.65%)和头孢替坦(22.05%)耐药率较低;碳青霉烯类药物中,对亚胺培南(24.05%)和美罗培南(23.00%)的耐药率较高,对厄他培南的耐药率较低(14.95%);氨基糖苷类药物中,对阿米卡星(17.75%)、庆大霉素(28.15%)和妥布霉素(21.75%)的耐药率较低,对环丙沙星(33.85%)和左氧氟沙星(33.10%)耐药率较高;未检出对替加环素耐药的肺炎克雷伯菌。结论该院分离的肺炎克雷伯菌的感染类型多样化,耐药情况较严重,呈缓慢上升趋势,并没有出现某些药物耐药率下降现象,因此应加大力度整治抗生素滥用现象。

Objective To retrospectively analyze the current status of drug resistance of Klebsiella pneumoniae in a hospital and provide guidance and recommendations for clinical treatment.Methods Collecting 784 strains of Klebsiella pneumoniae from 2018 to 2019 in a tertiary hospital,and count the source of the specimens.The VITEK^(■)2Compact automatic microbial analyzer was used to identify the strains and test for drug sensitivity.K-B method was used in manual drug susceptibility test to analyze the drug resistance of Klebsiella pneumonia in the hospital.Results 784 strains of Klebsiella pneumoniae were mainly derived from sputum specimens(50.51%),followed by blood specimens(15.22%),urine specimens(13.91%),and other specimens including wounds,bile,excreta,abdominal drainage,indwelling tube and abscess,etc.(20.36%);From 2018 to 2019,the overall resistance of Klebsiella pneumoniae in the hospital showed a slow upward trend;Among cephalosporins,the resistance rate to cefazolin(46.82%)and ceftriaxone(44.15%)was higher.Low resistance rate to ceftazidime(32.75%),cefepime(27.65%)and cefotetan(22.05%);Among carbapenem drugs,the resistance rate to imipenem(24.05%)and meropenem(23.00%)was higher,and the resistance rate to ertapenem was lower(14.95%);Among the aminoglycoside drugs,the resistance rate to amikacin(17.75%),gentamicin(28.15%)and tobramycin(21.75%)was low,and the resistance rate to ciprofloxacin(33.85%)and Levofloxacin(33.10%)had a higher resistance rate;Klebsiella pneumoniae resistant to tigecycline was not detected.Conclusion The infection types of Klebsiella pneumoniae isolated from this hospital are diversified,and the drug resistance is relatively serious,showing a slow upward trend.There is no decline in the drug resistance rate of certain drugs.Therefore,we should increase efforts to rectify the abuse of antibiotics.