多重耐药肺炎克雷伯菌血流感染临床分布及耐药分析

Analysis of clinical distribution and drug resistance of multidrug resistant-Klebsiella pneumoniae in bloodstream infection

目的 分析多重耐药肺炎克雷伯菌(MDR-KP)血流感染(BSI)的临床分布及耐药情况,为促进临床合理治疗MDR-KP引起的BSI提供指导。方法 根据绍兴市人民医院(浙江大学绍兴医院)2005—2020年血液样本中分离出的405株肺炎克雷伯菌(KP)的药敏结果,筛选出134例MDR-KP,收集临床资料、药敏数据进行统计分析。结果 MDR-KP检出率为0.49%~4.20%。≤40岁组检出率最高,占46.67%。MDR-KP来源前3位的科室分别为ICU(23.88%)、肝胆外科(23.13%)和血液科(9.70%)。体外药敏试验结果显示,MDR-KP对临床常用抗生素如第1~3代头孢菌素类、β-内酰胺类/酶抑制剂类、头霉素类、喹诺酮类、单酰胺环类、磺胺类的总体不敏感率高,仅对碳青霉烯类、氨基糖苷类、甘氨酰环肽类不敏感率低于50%。碳青霉烯类药物的不敏感率呈上升趋势,美罗培南、亚胺培南、厄他培南总体不敏感率分别为8.62%、19.40%、24.78%。结论 MDR-KP在BSI中的检出率及耐药率呈上升趋势,对多种常用抗菌药物耐药率高,应加强对分离率高的科室及人群的监测。

Objective To analyze the clinical distribution and drug resistance of multidrug resistant-Klebsiella pneumoniae(MDR-KP) in bloodstream infection(BSI). Methods A retrospective analysis of clinical and drug susceptibility data was performed on 134 MDR-KP cases in Shaoxing People’s Hospital from 2005 to 2020. Results The detection rate of MDR-KP ranged from 0.49% to 4.20%. The highest detection was in the ≤40 age group, accounting for 46.67%. The top three departments of MDR-KP sources were ICU(23.88%), hepatobiliary surgery(23.13%), and hematology(9.70%). The results of in vitro drug susceptibility tests showed that MDR-KP was effective against commonly used clinical antibiotics, including first to third generation cephalosporins, β-lactams/enzyme inhibitors, cephamycins, quinolones, monoamide rings, sulfonamides.The overall insensitivity rate was high, while the insensitivity rate to carbapenems, aminoglycosides, and glycyl cyclic peptides was <50%. The insensitivity rate of carbapenems showed a upward trend. Conclusion The detection rate and drug resistance rate of MDR-KP in BSI have increased, and the drug resistance rate to a variety of commonly used antibacterial drugs is high. The monitoring of departments and populations with high isolated rate should be strengthened.