某三级医院2019—2021年肺炎克雷伯菌临床分布及耐药变迁分析

Analysis of Clinical Distribution and Drug Resistance Changes of Klebsiella pneumoniae in a Tertiary Hospital from 2019 to 2021

目的分析2019—2021年湖南省安化县人民医院分离的肺炎克雷伯菌(KP)的临床分布及耐药变迁情况,了解本地区肺炎克雷伯菌的流行特征。方法收集我院近3年分离出的肺炎克雷伯菌,比较不同年度、不同科室、不同标本检出情况及耐药变化趋势。结果我院近3年KP检出率逐年升高,分别为16.4%、20.6%、22.2%(χ^(2)=28.0,P<0.001)。主要来源于下呼吸道标本,占比82.9%,其次是中段尿7%,脓液3.5%,血液2.9%。KP对碳青霉烯类药物耐药率呈上升趋势,亚胺培南和美罗培南分别为:2019年0.7%、1.2%,2020年1.9%、2.1%,2021年12.6%、12.8%。耐碳青霉烯肺炎克雷伯菌(CRKP)主要来源于神经外科和重症医学科。结论近3年间KP的检出率和耐药率逐年上升,尤其是耐碳青霉烯肺炎克雷伯菌检出率攀升情况不容忽视。神经外科和重症医学科需重点加强耐药菌感染防控,进一步合理使用抗菌药物。

Objective To analyze the clinical distribution and drug resistance changes of Klebsiella pneumoniae(KP)isolated from Anhua County People’s hospital of Hunan province from 2019 to 2021,and to investigate the epidemiological characteristics of KP in this region.Methods KP isolated from the microbiology department of our hospital in recent 3 years were collected,and the detection situation and drug resistance trend of different years,different departments and different specimens were compared.Results KP separation rates in our hospital increased year by year,respectively 16.4%、20.6%、22.2%,(χ^(2)=28.0,P<0.001).Bacteria were mainly isolated from lower respiratory tract specimens,accounting for 82.87%,followed by mid-stream urine 7%,pus 3.54%,blood 2.86%.The drug resistance rate of KP to carbapenems was increasing,with 0.7%and 1.2%of imipenem and meropenem in 2019,1.9%and 2.1%in 2020,and 12.6%and 12.8%in 2021.Carbapenem-resistant Klebsiella pneumoniae(CRKP)mainly came from neurosurgery and intensive care medicine.Conclusion In recent 3 years,the detection rate and drug resistance rate of KP increased year by year,especially the increase of carbapenem-resistant Klebsiella pneumoniae detection rate,which should not be ignored.Neurosurgery department and intensive care unit should focus on strengthening the prevention and control of drug-resistant bacteria infection and further rational use of antibacterial drugs.