2017年—2020年4634株肺炎克雷伯菌的临床分布及耐药性分析

Analysis of clinical distribution and drug resistance of 4634Klebsiella pneumoniae isolates from 2017 to 2020

目的调查肺炎克雷伯菌临床分离株的分布及对常用抗菌药物的耐药性,为控制医院内感染及合理使用抗菌药物提供依据。方法收集2017年1月—2020年6月温州医科大学附属第一医院从各种标本分离的4 634株肺炎克雷伯菌。常规方法进行细菌分离培养,用VITEK全自动微生物分析仪对肺炎克雷伯菌进行菌种鉴定和药敏试验。结果肺炎克雷伯菌引起的感染夏秋季明显高于春冬季,主要分离自痰液、血液及尿液,肺炎克雷伯菌医院感染高发科室为中心重症监护病房(ICU),占15.90%。在18种临床常用抗菌药物中,肺炎克雷伯菌对氨苄西林的耐药率最高(87.99%),对阿米卡星的耐药率最低(7.47%),肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率呈逐年缓慢下降的趋势。碳青霉烯类耐药肺炎克雷伯菌(CRKP)和碳青霉烯敏感肺炎克雷伯菌(CSKP)对常用抗菌药物的耐药率差异有统计学意义(P<0.001)。结论肺炎克雷伯菌的临床分离率高,耐药情况严重,应加强细菌耐药监测,合理使用抗菌药物。

Objective To investigate the distribution and antimicrobial resistance profiles ofKlebsiella pneumoniaeclinical isolates, so as to provide basis for the rational use of antibiotics.Methods A total of 4 634 K. pneumoniaeisolates were collected from specimens of patients at the First Affiliated Hospital of Wenzhou Medical University from January 2017 to June 2020. The identification and antimicrobial susceptibility testing forK. pneumoniaeisolates were conducted by VITEK full automated microbiology analyzer.Results The infections caused byK. pneumoniaewere higher in summer and autumn than that in spring and winter. Most of the patients withK. pneumoniaeinfections were from sputum, blood and urine, and theK. pneumoniaeinfections were highly prevalent in ICU(15. 90%). The highest resistance rate ofK. pneumoniaeto 18 antimicrobial agents was ampicillin(87. 99%), and the lowest resistance rate was amikacin(7. 47%). The prevalence of Carbapenems resistance amongK. pneumoniaedeclined slowly year by year. The difference of carbapenem-resistantK. pneumonia( CRKP) and carbapenem-susceptibleK. pneumonia(CSKP) was statistically significant(P< 0. 001).Conclusion The clinical isolation rate and resistance rate ofK. pneumoniaeisolates are high and serious, so it is necessary to monitor drug resistance and use antimicrobial drugs rationally.