2017-2019年耐碳青霉烯类肺炎克雷伯菌(CRKP)的检出率及耐药性变化趋势分析

2017-2019 CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIA(CRKP)ANALYSIS OF DETECTION RATE AND CHANGE TREND OF DRUG RESISTANCE

目的:通过对碳青霉烯类耐药肺炎克雷伯菌(CRKP)的检出率及耐药性变化趋势分析,指导临床合理用药。方法:对2017-01~2019-12分离出的409株CRKP的分离率、标本来源和病区分布,以及耐药性进行变迁分析。结果:409株CRKP构成比从高到低的标本为痰液(54.0%)、尿液(30.1%)、血液(9.3%)和分泌物(5.4%);CRKP检出率从高到低的标本为分泌物(30.1%)、尿液(27.9%)、血液(25.7%)和痰液(20.2%)。2017~2019年,从痰液和尿液分离出的CRKP呈明显上升趋势,差异均具有统计学意义(P<0.05)。409株CRKP构成比从高到低的科室为干部保健病房(30.8%)、ICU(26.9%)、神经内科(12.2%)、呼吸内科(9.8%)和神经外科(4.9%);CRKP检出率从高到低的病区为ICU(47.8%)、神经内科(43.1%)、干部保健病房(32.6%)、呼吸内科(19.3%)和神经外科(10.0%)。2017~2019年从ICU、神经外科、神经内科、呼吸内科及干部保健病房分离出的CRKP呈明显升高趋势,差异均有统计学意义(P<0.05)。2017~2019年全院CRKP的检出率分别为3.2%、26.5%和28.1%,呈增长趋势,差异具有统计学意义(P<0.05)。CRKP对18种药物的耐药率均大于82.4%;2017~2019年CRKP的耐药率,头孢吡肟有下降趋势,复方新诺明、阿米卡星、庆大霉素、呋喃妥因及妥布霉素有升高趋势。结论:CRKP的检出率呈增长趋势,耐药程度严重;实验室应及时报告和监测CRKP;临床应规范使用抗菌药物,加强环境消毒和手卫生,降低CRKP的感染率。

Objective:The detection rate of carbapenem-resistant Klebsiella pneumoniae(CRKP)and drug resistance trend analysis,clinical therapy.Methods:The isolation rate,source of specimens,distribution of disease areas,and drug resistance of 409 CRKP strains isolated from January 2017 to December 2019 were analyzed.The statistical software Whonet 5.6 was used for data analysis,the SPSS 20 software was used for the significance analysis,and the X2 test was used for the comparison of resistance rates.Results:409 CRKP composition ratio descending sputum specimens(54.0%),urine(30.1%),the blood(9.3%)and secretions(5.4%);CRKP detection rate from high to low specimens are secretions(30.1%),urine(27.9%),blood(25.7%)and sputum(20.2%).2017-2019 years was significantly increased from sputum and urine separated CRKP,the differences were statistically significant(P<0.05).The departments with high to low CRKP composition ratios of 409 strains were cadre health ward(30.8%),ICU(26.9%),neurology(12.2%),respiratory medicine(9.8%)And neurosurgery(4.9%);CRKP detection rate was descending ward ICU(47.8%),Department of Neurology(43.1%),health-care ward cadres(32.6%),respiratory medicine(19.3%)And neurosurgery(10.0%).From 2017 to 2019,CRKP isolated from ICU,neurology,cadre health ward,respiratory medicine,and neurosurgery showed a significant upward trend,and the differences were statistically significant(P<0.05).From2017 to 2019,the detection rates of CRKP in the whole hospital were(3.2%),(26.5%)and(28.1%),showing an increasing trend,and the difference was statistically significant(P<0.05).The resistance rate of CRKP to compound trimethoprim was 82.4%,and the resistance rate of the other 17 antibacterial drugs exceeded 92.9%;the resistance rate of CRKP to cefepime declined in 2017-2019,and the resistance rate to amika The drug resistance rates of Star,Gentamicin,Tobramycin,Compound Trimethoprim and Nitrofurantoin have increased.Conclusion:The detection rate of CRKP is increasing,and the degree of drug resistance is serious;laboratories should report and monitor CRKP in time;clinical use of antibacterial drugs should be standardized,environmental disinfection and hand hygiene should be strengthened,and the infection rate of CRKP should be reduced.