COVID-19疫情防控措施对肺炎克雷伯菌的分布及耐药性的影响

Influence of COVID-19 targeted prevention and control measures on the distribution and drug resistance transition of Klebsiella pneumoniae

目的了解呼吸与危重症医学科新型冠状病毒肺炎(COVID-19)疫情前后肺炎克雷伯菌(KP)分布状况、耐药KP检出比例及耐药性变化趋势,为临床合理使用抗生素和病原菌耐药性研究提供科学依据。方法应用WHONET 5.6软件收集并首次分析了疫情前(2019年1月~12月)及疫情常态化防控后(2020年5月~2021年4月)成都大学附属医院呼吸与危重症医学科病原微生物培养的样本,比较分析疫情前后样本来源KP菌株、耐药KP检出率,耐药KP对常见抗感染药物耐药性检出差异。结果新冠疫情前1年内及疫情常态化防控1年中样本来源均以痰液/支气管液为主;常态化防控后1年各种标本中KP的分离比例较防控前显著上升(P<0.05)。疫情前1年KP耐药前五位抗生素为氨曲南(26.39%)、头孢他啶(26.39%)、头孢噻肟(25.46%)、氨苄西林/舒巴坦(24.54%)、复方新诺明(18.06%);疫情常态化防控后1年检出耐药KP前五位的抗生素为头孢噻肟(29.78%)、氨曲南(29.21%)、头孢他啶(29.21%)、氨苄西林/舒巴坦(25.84%)、环丙沙星(16.29%)、厄他培南(16.29%)。疫情前后比较,对复方新诺明耐药率显著下降(均P<0.05)。常态化防控前后产ESBL肺炎克雷伯菌耐药率差异无统计学意义(均P>0.05)。结论COVID-19疫情的发生导致KP检出情况及耐药性均发生了变化,应引起临床高度重视,疫情常态化防控期间应对KP感染采取精准积极的干预措施,加强KP检出患者的管理并合理选用抗生素,减少耐药KP的产生与传播。

Objective To analyze the distribution and drug resistance change of Klebsiella pneumoniae(KP)isolates from the patients hospitalized in the department of respiratory and critical care medicine before and after COVID-19 Pandemic,and provide references for further proper use of antibiotics.Methods Data of pathogens in the year pre COVID-19 Pandemic(Jan to Dec,2019)and post Pandemic year(May 2020 to Mar 2021)were collected by the WHONET 5.6 software.The source of specimens,detection rate of KP,detection rate drug resistant KP,and drug resistance profiles were compared.Results Specimens used for microbiological examination were mainly sputum and bronchoalveolar lavage fluids.The detection rate of KP isolates from the post Pandemic year was significantly higher than those from pre-Pandemic year(P<0.05).Drug resistant KP had higher resistance rates to aztreonam(26.39%),ceftazidime(26.39%),cefotaxime(25.46%),piperacillin/tazobactam(24.54%),and compound sulfamethoxazole(18.06%)in the pre-Pandemic year,and to cefotaxime(29.78%),aztreonam(29.21%),piperacillin/tazobactam(25.84%),ciprofloxacin(16.29%)and ertapenem(16.29%).Compared to the pre-Pandemic year,resistance rates of KP against compound sulfamethoxazole decreased significantly in the post Pandemic year(P<0.05).No significantly change was observed in resistance rates of ESBL-KP(P<0.05).Conclusion COVID-19 Pandemic has remarkably influenced the isolation rate of KP.It is suggested that precise and active intervention measures should be taken to prevent the emergence and prevalence of drug resistant KP in the period of COVID-19 epidemic.