漯河地区医院2017年-2020年检出的碳青霉烯耐药的肺炎克雷伯菌的临床分布及耐药情况分析

Analysis of Clinical Distribution and Drug Resistance of Carbapenem-Resistant Klebsiella Pneumoniae Detected in Hospitals of Luohe District from 2017 to 2020

目的:探究漯河地区医院2017年-2020年碳青霉烯耐药的肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)分布特点及其耐药情况。方法:收集漯河地区医院2017年1月—2020年12月临床分离出的肺炎克雷伯菌(KP)4 652株的检测数据,分析4年间KP菌株中临床CRKP检出率、标本来源、科室分布和CPKP耐药特点。结果:4 652株KP菌株中,CRKP检出率为9.42%;其中2017年分离出KP 1 053株,检出CRKP86株(占8.17%);2018年分离出的KP 1 079株,检出CRKP 102株(占9.45%);2019年分离出KP 1 126株,检出CRKP 110株(占9.77%);2020年分离出KP 1 394株,检出CRKP 140株(占10.04%);标本主要来源于呼吸道分泌物(占36.53%),其次是尿液(24.20%)、血液(16.21%)、痰液(13.70%)、伤口分泌物(7.31%)和其他(2.05%);CPKP检出科室以ICU(36.76%)为主,其他依次为急诊科(14.16%)、呼吸内科(14.16%)、老年病科(11.87%)、泌尿科(10.50%)、肝脏外科(6.16%)、儿科(5.48%)和心内科(0.91%);药敏结果发现CRKP对头孢曲松、替加环素、多黏菌素B的耐药率相对较低(分别为46.58%、47.95%和15.07%),而其对氨曲南、左氧氟沙星、环丙沙星、头孢他啶、头孢吡肟的耐药率均大于80.00%;其对氨苄西林、哌拉西林-他唑巴坦、亚胺培南的耐药率均达100.00%。结论:漯河地区医院CRKP检出率呈逐年上升趋势,且主要集中分布于ICU,主要标本来源于呼吸道分泌物;且CRKP对常用抗菌药物均呈高耐药性,临床应加强对细菌耐药的监测,按药敏结果选用敏感率高的抗菌药物治疗,以确保患者治疗的有效性。

Objective: To investigate the distribution characteristics and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP) in hospitals of Luohe district from 2017 to 2020. Methods: The detection data of 4 652 strains of Klebsiella pneumoniae(KP) isolated from Luohe Regional Hospital from January 2017 to December 2020 were collected, and the clinical detection rate of CRKP, specimen source, department distribution and drug resistance characteristics of CRKP in KP strains during the 4 years were analyzed. Results: In 4 652 strains of KP, the detection rate of CRKP was 9.42%. In 2017, 1 053 strains of KP were isolated, and 86 strains of CRKP were detected, accounting for 8.17%. In 1 079 strains of KP isolated in 2018, 102 strains of CRKP were detected, accounting for 9.45%. In 2019,1 126 strains of KP were isolated, and 110 strains of CRKP were detected, accounting for 9.77%. In 2020, 1 394 strains of KP were isolated, and 140 strains of CRKP were detected, accounting for 10.04%. The samples were mainly from respiratory secretions(36.53%), followed by urine(24.20%), blood(16.21%), sputum(13.70%), wound secretions(7.31%) and others(2.05%). CRKP was detected mainly in ICU(36.76%), followed by emergency department and respiratory department(14.16%),geriatrics department(11.87%), urology department(10.50%), liver surgery department(6.16%), pediatrics department(5.48%) and cardiology department(0.91%). Drug sensitivity results showed that the drug resistance rates of CRKP to ceftriaxone, tigecycline and polymyxin B were relatively low(46.58%,47.95% and15.07%,respectively), while the drug resistance rates of CRKP to aztreonam, levofloxacin, ciprofloxacin, ceftazidime and cefepime were all more than 80.00%. The drug resistance rates to ampicillin, piperacillin-tazobactam and imipenem were 100.00%. Conclusion: The detection rate of CRKP in hospitals in Luohe district increased year by year, mainly distributed in ICU, and the main specimens were from respiratory secretions. In addition, CRKP is highly resistant to commonly used antibacterials, so clinical monitoring of bacterial resistance should be strengthened, and antibiotics with high sensitivity rate should be selected based on drug sensitivity results to ensure the effectiveness of treatment for patients.