2013-2019年某三级综合医院肺炎克雷伯菌分布及耐药性分析

Analysis on distribution and drug resistance of Klebsiella pneumoniae in a tertiary comprehensive hospital from 2013 to 2019

目的了解上海某三级综合医院2013-2019年临床分离的肺炎克雷伯菌(KPN)分布和耐药性变迁,为临床合理使用抗菌药物提供参考。方法对同济大学附属杨浦医院2013-2019年临床分离的KPN分布及耐药性进行回顾性分析。结果2013-2019年共分离出KPN 3520株,主要来自呼吸道标本(59.4%)、尿液(22.3%)、血液(5.5%)和胆汁(3.9%)标本。97.2%菌株分离自住院患者,其中重症监护室(ICU)的KPN分离率(15.5%)和耐碳青霉烯类肺炎克雷伯菌(CRKPN)检出率(14.7%)均是最高的。2013-2019年KPN对亚胺培南(IPM)和美罗培南(MEM)的耐药率呈现逐年上升的趋势,从2013年的5.1%和6.2%上升至2019年的28.6%和29.2%。CRKPN对多数抗菌药物的耐药率明显高于非CRKPN(P<0.05)。其中,对IPM和MEM同时耐药的KPN对多数抗菌药物的耐药率>80.0%。ICU分离的KPN对大多数抗菌药物的耐药率均明显高于外科、内科和门诊(P<0.05)。从>65岁患者中分离的KPN对受试的所有抗菌药物的耐药率均高于从≤65岁患者中分离的KPN(P<0.05)。不同标本中,从尿液中分离的KPN对受试的所有抗菌药物耐药率均明显高于呼吸道标本和血液标本(P<0.05)。结论医院分离的KPN耐药情况非常严峻,分离自不同年龄段、科室和标本的菌株对抗菌药物的耐药性相差较大,必须加强抗菌药物管理,继续开展病原菌分布及其耐药性监测,用于指导临床医师合理使用抗菌药物,控制耐药菌株在医院中的流行。

Objective To investigate the distribution and drug resistance of Klebsiella pneumoniae(KPN)isolated from a tertiary comprehensive hospital in Shanghai from 2013 to 2019,which to provide reference for clinical rational use of antimicrobial drugs.Methods The clinical distribution and drug resistance of KPN isolated from clinical specimens in Yangpu Hospital of Tongji University from 2013 to 2019 were retrospectively analyzed.Results A total of 3520 strains of KPN were isolated from 2013 to 2019,mainly from samples of respiratory tract(59.4%),urine(22.3%),blood(5.5%)and bile(3.9%).97.2%of the strains were isolated from hospitalized patients.The isolation rate(15.5%)of KPN and the detection rate(14.7%)of carbapenem resistant Klebsiella pneumoniae(CRKPN)in intensive care unit(ICU)were the highest.From 2013 to 2019,the resistance rates of KPN to imipenem(IPM)and meropenem(MEM)increased year by year,from 5.1%and 6.2%in 2013 to 28.6%and 29.2%in 2019.The resistance rate of CRKPN to most antimicrobial drugs was significantly higher than that of non-CRKPN(P<0.05).Among them,the resistance rates of KPN which was resistant to both IPM and MEM to most antimicrobial drugs were more than 80.0%.The resistance rate of KPN isolated from ICU to most antimicrobial drugs was significantly higher than those of departments of surgery,internal medicine and outpatient(P<0.05).The drug resistance rates of KPN isolated from patients>65 years old were significantly higher than those from patients≤65 years old(P<0.05).In different samples,the drug resistance rates of KPN isolated from urine were significantly higher than those of respiratory tract samples and blood samples(P<0.05).Conclusion The drug resistance candition of KPN isolated in hospital is very serious.The drug resistance of KPN isolated from specimens of different age groups,departments and specimens varies greatly.It is necessary to strengthen the management of antimicrobial drugs,continue to carry out the pathogenic bacteria distribution and drug resistance surveillance,which to guide clinical rational use of antimicrobial drugs and control the epidemic of drug resistant strains in hospital.