某医院2018年检出的肺炎克雷伯菌临床分布及耐药性分析

Analysis on clinical distribution and drug resistance of Klebsiella pneumoniae detected in a hospital in 2018

目的调查肺炎克雷伯菌的分布特征及其耐药特征,为抗菌药物的合理使用提供参考。方法收集某医院2018年全年分离的肺炎克雷伯菌共1241株,检测其对临床常用的17种抗菌药物的耐药性,对其耐药率及科室、患者年龄等分布特征进行统计分析。结果1241株肺炎克雷伯菌中,内科重症监护室(ICU)所占比例最高(39.89%),外科ICU(21.03%)、结核ICU(10.15%)、移植外科(5.96%)次之。临床标本主要来源为痰液(37.47%)、尿液(25.79%)、脓液(18.61%)、血液(7.66%)。除复方磺胺甲噁唑(30.78%)外,菌株对其他16种药物的耐药率均≥56.65%,ICU科室的整体耐药率高于非ICU科室(P<0.05)。碳青霉烯类药物亚胺培南、美罗培南总体耐药率均较高,分别为69.70%、69.54%,且与患者年龄呈正相关(r 2=0.89,P<0.05)。结论肺炎克雷伯菌对常用抗菌药物广泛耐药,ICU的耐药率高于其他科室。碳青霉烯类药物耐药率较高,且与患者年龄呈正相关。

Objective To investigate the distribution characteristics and drug resistance characteristics of Klebsiella pneumoniae(K.pneumoniae)isolated from clinical specimens and provide references for the rational use of antibacterial drugs.Methods A total of 1241 strains of K.pneumoniae isolated from a hospital in 2018 were collected,and their resistance to 17 commonly used antimicrobial drugs in clinical practice were detected.Their drug resistance rate,department,age and other distribution characteristics were statistically analyzed.Results Among the 1241 strains of K.pneumoniae,internal medicine intensive care unit(ICU)accounted for the highest proportion(39.89%),followed by surgical ICU(21.03%),tuberculous ICU(10.15%)and transplant surgery(5.96%).The main sources of clinical specimens were sputum(37.47%),urine(25.79%),pus(18.61%),and blood(7.66%).Except for compound sulfamethoxazole(30.78%),the antibiotic resistance rates of other 16 drugs were all no less than 56.65%.The overall drug resistance rate of ICU departments was higher than that of non-ICU departments(P<0.05).The resistance rates of carbapenem antibiotics such as imipenem and meropenem were 69.70%and 69.54%,respectively,and the resistance rates were positively correlated with the patient′s age(r 2=0.89,P<0.05).Conclusion K.pneumoniae is widely resistant to commonly used antibacterial drugs,and the drug resistance rate in ICU is higher than other departments.The carbapenem drug resistance rate is relatively high,and it is positively correlated with the patient′s age.