近5年肺炎克雷伯菌的临床分布特点及耐药性变迁

Clinical distribution characteristics and drug resistance of Klebsiella pneumoniae in recent 5 years

目的 分析临床标本中肺炎克雷伯菌的科室分布与耐药情况,为临床合理使用抗菌药物、降低细菌耐药率及控制医院感染提供依据。方法 回顾分析2015~2019年我院临床各种标本分离出的2 296株肺炎克雷伯菌的临床科室分布、标本来源以及耐药情况。结果 获取非重复分离的肺炎克雷伯菌2 296株,主要标本为痰、血液、尿液、脓及分泌物,分别检出1 697(73.91%)、161(7.01%)、161(7.01%)、115(5.01%)株;科室分布主要为神经外科、重症医学科(ICU)、儿科、新生儿科、肝胆科和呼吸科,分别检出360(15.68%)、330(14.37%)、313(13.63%)、261(11.37%)、126(5.49%)、122(5.31%)株;肺炎克雷伯菌对头孢他啶、头孢噻肟、头孢吡肟、哌拉西林、氨苄西林/舒巴坦、氨曲南和四环素等在2015~2019年的最低耐药率分别为26.51%、32.15%、28.81%、34.44%、30.89%、28.81%、23.77%,对亚胺培南、美罗培南的耐药率呈逐年升高趋势,从2015年的0.98%、0.98%升高至2019年的8.14%、6.88%,其中ICU和呼吸科对亚胺培南、美罗培南的耐药率最高,分别为17.02%、14.90%和30.77%、30.77%。结论 我院肺炎克雷伯菌耐药严重并且碳青霉烯类的耐药率逐年上升,医院需加强对肺炎克雷伯菌感染者的目标性监测,指导临床正确且合理使用抗菌药物,有效预防和控制耐药菌的蔓延。

Objective To analyze the distribution and drug resistance of Klebsiella pneumoniae in clinical samples, to provide guidance for rational use of antibiotics, to reduce drug resistance rate of bacteria, and to control the hospital infection.Methods 2 296 strains of Klebsiella pneumoniae isolated from clinical specimens of our hospital from 2015 to 2019 were analyzed retrospectively.Results 2 296 strains of Klebsiella pneumoniae were isolated. The main samples were sputum, blood, urine, pus and secretion. The detection rates were 1 697(73.91%), 161(7.01%), 161(7.01%) and 115(5.01%) respectively. The detection rates in neurosurgery department, intensive care unit(ICU), neonate department, hepatobiliary surgery and respiratory department were 360(15.68%), 330(14.37%), 313(13.63%), 261(11.37%), 126(5.49%) and 122(5.31%), respectively. The lowest drug resistance rates of Klebsiella pneumoniae to ceftazidime, cefotaxime, cefepime, piperacillin, ampicillin/sulbactam, aztreonam and tetracycline were 26.51%, 32.15%, 28.81%, 34.44%, 30.89%, 28.81% and 23.77%, respectively, from 2015 to 2019, and the drug resistance rates of imipenem and meropenem increased significantly year by year, from 2015(0.98%, 0.98%) to 2019(8.14%, 6.88%), and the most serious thing was that the drug resistance rates of imipenem and meropenem in ICU and respiratory departments were the highest, which were(17.02%, 14.90%) and(30.77%, 30.77%), respectively.Conclusion The drug resistance of Klebsiella pneumoniae in our hospital is serious and the resistance rate of carbapenems is increasing year by year. The hospital should strengthen the target monitoring of Klebsiella pneumoniae infection, guide the clinical correct and reasonable use of antibiotics, and effectively prevent and control the spread of drug-resistant bacteria.