2015—2020年耐碳青霉稀类肺炎克雷伯菌感染特点及耐药性分析

Infection characteristics and drug resistance analysis of Carbapenem-resistant Klebsiella pneumoniae from 2015 to 2020

目的分析耐碳青霉烯类肺炎克雷伯菌(CRKP)感染特点及耐药性,为临床合理使用抗菌药物提供参考。方法收集2015年1月到2020年1月住院患者临床分离的800株肺炎克雷伯菌,计算CRKP检出率,分析CRKP标本来源、科室、年龄分布情况,分析血流感染情况,检测CRKP菌株对抗菌药物敏感性及产碳青霉烯酶基因型。结果2015年1月到2020年1月共收集到临床分离CRKP菌株150株,检出率18.75%;CRKP标本主要来源于支气管肺泡灌洗液/痰,有78株,占52.00%;CRKP主要来源科室为重症监护病房(49/150,32.67%),以40~60岁患者为CRKP主要感染人群(61/150,40.67%);CRKP首次分离标本来源后发生血流感染20例,占13.33%;CRKP对替加环素、阿米卡星、磷霉素敏感性较高,分别为95.33%、85.33%、89.34%,对其余抗生素耐药率均较高;CRKP菌株产碳青霉烯酶基因以KPC型为主,占84.89%。结论CRKP感染率逐年升高且对大多抗生素高度耐药,尤其针对重症监护科以及长期住院患者,应加强对CRKP的监测,并根据药敏结果合理用药。

Objective To analyze the infection characteristics and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)and provide reference for clinical rational use of antibiotics.Methods A total of 800 strains of Klebsiella pneumoniae isolated from inpatients from January 2015 to January 2020 were collected;The detection rate of CRKP was calculated,and the specimen source,department distribution,and age distribution of CRKP were analyzed.The incidence rate of bloodstream infection was analyzed.The susceptibility of CRKP strains to antimicrobial agents and the genotype of carbapenems were detected.Results A total of 150 CRKP strains were collected from January 2014 to January 2019,with a detection rate of 18.75%.CRKP samples were mainly isolated from bronchoalveolar lavage fluid/sputum(78 strains,52.00%).The main source department of CRKP was ICU(49/150,32.67%),and patients aged 40-60 years were the main infected population(61/150,40.67%).There were 20 cases of bloodstream infection(13.33%)after the first separation of CRKP samples.The sensitivity of CRKP to tigecycline,amikacin and fosfomycin was 95.33%,85.33%and 89.34%,respectively.The maincarbapenemase gene of CRKP strains was KPC,accounting for 84.89%.Conclusion The infection rate of CRKP isincreasing year by year,and is highly resistant to most antibiotics,so the clinical monitoring of CRKP should bestrengthened among the ICU and long-term hospitalized patients,and rational drug use should be conducted accordingto drug sensitivity results.