外伤急诊患者不同标本类型肺炎克雷伯菌耐药性分析

Analysis of resistance towards antibacterial agents of Klebsiella pneumoniae from different clinical samples

目的分析2012—2019年肺炎克雷伯菌(Klebsiella pneumoniae)耐药性变化及其在不同标本类型、不同性别中的耐药性差异,为临床合理使用抗菌药物提供理论依据。方法对某院2012年10月—2019年6月收集的肺炎克雷伯菌数据进行回顾性分析,比较不同标本类型、不同性别间该菌株耐药性差异。结果共收集肺炎克雷伯菌2507株,最常见的标本类型为痰液、尿液、分泌物;8年间肺炎克雷伯菌耐药率呈上升趋势;与痰液、分泌物相比,尿液标本类型菌株耐药率最高;不同标本肺炎克雷伯菌耐药率在不同性别患者中有所不同。结论该院不同标本类型和不同性别患者肺炎克雷伯分离菌对抗菌药物耐药性相差较大,应及时进行病原学检查,依据药敏结果合理选用抗生素,提高医师经验用药准确率。

Objective To investigate the resistance towards antibacterial agents of the Klebsiella pneumoniae(KP)in different clinical specimens from patients of different gender 2012 to 2019,so as to provide a theoretical basis for the clinical rational use of antibacterial drugs.Methods 2507 samples(secretions,urine,sputum,hydrothorex,ascitic fluid,and blood)were collected from 2507 patients,1790 males and 717 females,admitted in a hospital in Beijing from October 2012 to June 2019 KP was retrieved.Their resistance rates towards 19 antibacterial agents were studied.Results There were no significant differences in the resistance rates towards cefazolin,ampicillin,trimethoprim and sulphame-thoxazole,chloramphenicol,imipenem;,and tetracycline among the KP from urine,sputum,and secretions.However,the resistance rates towards trimethoprim and sulphame-thoxazole,chloramphenicol,imipenem;,and tetracycline of the KP.from the urine and secretions were significantly higher than those from sputum.The resistance rates towards amoxicilin-clavldantic acid,aztreonam,ciprofloxacin,chloramphenicol,piperacillin,gentamycin,tetracycline,cefepime,cefotaxime,ceftazidime,and levofloxacin of the KP from the sputum of the female patients were all significantly higher than those of the male patients(all P<0.05).The resistance rates towards amikacin,amoxicilin-clavldantic acid,ampicillin-sulbactam,aztreonam,trimethoprim and sulphamethoxazole,ciprofloxacin,chloramphenicol,meropenem,piperacillin,gentamycin,cefepime,cefotaxime,ceftazidime,imipenem,and levofloxacin of the KP from the urine of the male patients were all significantly higher than those of the female patients(all P<0.05).There were no significant differences in the resistance rates towards other antibacterial agents among the KP from the specimens of secretions collected from different genders.Conclusion The resistance of K.pneumoniae isolates from the patients of different gender with different clinical types is quite different.Etiological examinations should be carried out in time,and antibacterial agents should be selected based on the results of drug.