某院2014年至2021年肺炎克雷伯菌临床特点及耐药性分析

Clinical Characteristics and Drug Resistance of Klebsiella Pneumoniae in a Hospital from 2014 to 2021

目的为临床合理选择治疗肺炎克雷伯菌(KPN)感染的抗菌药物提供参考。方法收集2014年1月至2021年12月某院临床科室送检标本中分离出KPN(共18895株)的报告,分析该菌的临床分布特点及耐药性(药物敏感性试验选择氨苄西林等18种临床常用药),计算不同抗菌药物的使用强度(AUD)。结果肺炎克雷伯菌为2016年至2021年该院临床分离的首要病原菌,8年间,该菌主要送检标本类型为痰液(64.36%);临床科室送检数排名前3的分别为脑外科(21.30%)、儿科(9.71%)、急救部(6.48%);KPN对18种抗菌药中近半数药物的耐药率在2017年达到峰值后呈下降或波浪形下降趋势,其中对替加环素的耐药率最低(0~4.7%);2014年,该院抗菌药物总AUD低于全国或重庆市水平,2015年起逐年上升,至2017年达峰值后逐步回落,2019年至2021年接近全国平均水平。结论KPN主要引起呼吸道感染,其对多种抗菌药物的耐药率呈下降趋势,临床应根据药物敏感性试验结果选药,以有效控制和减少耐药菌的产生。

Objective To provide a reference for the rational selection of antibiotics for clinical treatment of Klebsiella pneumoniae(KPN)infection.Methods The reports on the isolation of KPN(a total of 18895 strains)from specimens submitted by the clinical departments in the hospital from January 2014 to December 2021 were collected,the clinical distribution characteristics and drug resistance(selection of 18 commonly used clinical drugs such as ampicillin in the drug sensitivity test)of the bacteria were analyzed,and the antibiotics use density(AUD)was calculated.Results KPN was the main pathogen isolated from specimens submitted by the clinical departments in the hospital from 2016 to 2021.During the past eight years,the main type of specimens for the bacteria was sputum(64.36%).The top three clinical departments with more submitted specimens were Department of Brain Surgery(21.30%),Department of Pediatrics(9.71%)and Department of Emergency(6.48%).The resistance rate of KPN to nearly half of the 18 antibiotics showed a downward or wavy downward trend after reaching a peak in 2017,among which the resistance rate to tigecycline was the lowest(0-4.7%).In 2014,the total AUD in the hospital was lower than that in the whole country or Chongqing,it increased year by year since 2015,then gradually decreased after reaching a peak in 2017,and approached the national average level from 2019 to 2021.Conclusion KPN mainly induces respiratory tract infections,and its resistance rate to multiple antibiotics is decreasing.We should select drugs based on the drug sensitivity test in clinical practice to effectively control and reduce the generation of drug-resistant bacteria.