某院近10年肺炎克雷伯菌分离株来源及体外药物敏感性变迁

Sources of Klebsiella pneumoniae Isolated in a Hospital in the Past Decade and Trends and Changes of in vitro Drug Susceptibility

目的了解近10年某院临床样本中肺炎克雷伯菌(Klebsiella pneumoniae,KP)菌株的来源及体外药物敏感性,为KP相关感染的治疗提供临床依据。方法回顾性分析2012年1月–2021年12月期间该院临床样本中KP的检出率、样本来源和对抗菌药物的体外敏感性,对比分析产超广谱β-内酰胺酶与非产酶株、亚胺培南耐药株与敏感株的耐药率,采用碳青霉烯酶抑制剂增强试验检测菌株的碳青霉烯酶型别。结果从近10年来送检的1684668份临床样本中共分离到KP菌株34573株,占细菌分离株总数的14.6%。KP非重复株16888株,主要样本来源是痰液(10274/16888,60.8%)、血液(1913/16888,11.3%)和尿液(1876/16888,11.1%)。产超广谱β-内酰胺酶株的占比从2012年29.6%(409/1382)上升到2021年38.9%(967/2487),对抗菌药物的耐药率高于非产酶株(P<0.05)。亚胺培南耐药株的占比从2012年3.2%(44/1382)上升到2021年23.4%(583/2487),对抗菌药物的耐药率高于亚胺培南敏感株(P<0.05);产丝氨酸碳青霉烯酶菌株占91.1%(920/1010)。结论从临床样本中分离的KP菌株对抗菌药物的耐药性呈上升趋势,应注意监测分离株的体外药物敏感性和碳青霉烯酶型别,以指导临床用药。

Objective To investigate the source of Klebsiella pneumoniae(KP)isolated in a hospital in the past decade and the in vitro drug susceptibility,and to provide clinical references for the treatment of KP-associated infection.Methods The detection rate,the sources of the specimens,and in vitro susceptibility to antimicrobial agents of KP isolated from clinical specimens in a hospital between January 2012 and December 2021 were retrospectively analyzed.Resistance rate of the extended-spectrumβ-lactamases-producing isolates vs.that of the non-enzyme-producing ones,and the resistance rate of imipenem-resistant strains vs.that of imipenem-susceptible ones were compared and analyzed.Carbapenase inhibitor enhancement test was used to identify the types of the carbapenemases.Results In total,34573strains of KP were isolated from 1684668 clinical specimens,accounting for 14.6%of bacterial isolates.There were 16888 non-repeated strains of KP.The main specimen sources of the isolates were sputum(10274/16888,60.8%),blood(1913/16888,11.3%)and urine(1876/16888,11.1%).The proportion of extended-spectrumβ-lactamases-producing isolates increased from 29.6%(409/1382)in 2012 to 38.9%(967/2487)in 2021,and the resistance rate to antimicrobial agents was higher than that of non-enzyme-producing ones(P<0.05).The proportion of imipenem-resistant strains increased from 3.2%(44/1382)in 2012 to 23.4%(583/2487)in 2021,and the resistance rate to antimicrobial agents was higher than that of imipenem-susceptible strains(P<0.05).Serine carbapenase-producing strains accounted for 91.1%(920/1010).Conclusion The resistance to antimicrobial agents of KP strains isolated from clinical specimens increased.It is necessary to monitor the in vitro drug susceptibility and the type of the carbapenemases of the isolates in order to provide guidance for the clinical usage of antibiotics.