2018-2022年3342株肺炎克雷伯菌的临床分布及耐药性分析

Clinical distribution and drug resistance analysis of 3342 strains of Klebsiella pneumoniae from 2018 to 2022

目的分析肺炎克雷伯菌分离株的临床分布,筛查肺炎克雷伯菌菌株对临床常用抗菌药物的多重耐药性,为医院内感染的防控及抗菌药物的合理临床使用提供参考依据。方法收集2018年1月至2022年12月东南大学附属中大医院从临床送检的各类标本,对临床样本中细菌进行分离培养,通过VITEK全自动微生物分析仪对细菌进行菌种鉴定,这期间总共获得3342株非重复肺炎克雷伯菌,同时采用自动化药敏系统、纸片扩散法或标准肉汤微量稀释法对每株肺炎克雷伯菌进行药物敏感性试验,鉴定肺炎克雷伯菌耐药谱,分析临床送检样品中肺炎克雷伯菌检出率,以及与标本来源或科室类别关联性。结果肺炎克雷伯菌分离株来自痰液(42.07%)、尿液(14.81%)及血液(10.29%),肺炎克雷伯菌检出率比较高的科室依次为重症医学科(ICU)(35.19%)、神经外科(6.28%)、呼吸与危重症医学科(5.42%)。耐药性鉴定结果显示氨苄西林的耐药率最高(100.00%),耐药率最低的是阿米卡星(4.22%)。研究发现2018年至2021肺炎克雷伯菌对碳青霉烯类抗生素耐药率呈逐年增高的趋势,依次为2.94%、4.66%、7.90%、15.35%,但在2022年耐药率开始下降(5.38%)。碳青霉烯类耐药肺炎克雷伯菌(CRKP)耐药表型均为产KPC型菌株,且和碳青霉烯类敏感肺炎克雷伯菌(CSKP)对常用抗菌药物的耐药率差异有统计学意义(P<0.01)。结论肺炎克雷伯菌在临床分离率保持较高水平,同时耐药率高。应加强对院内细菌感染的防控及耐药性监测,针对肺炎克雷伯菌的治疗合理使用抗菌药物。

Objective To analyze the clinical distribution of Klebsiella pneumoniae isolates,screen for the multidrug resistance of Klebsiella pneumoniae strains to commonly used antimicrobial drugs,and provide reference for the prevention and control of hospital-acquired infections and rational clinical use of antimicrobial drugs.Methods Various clinical specimens collected from January 2018 to December 2022 at the Zhongda Hospital Affiliated to Southeast University were cultured to isolate bacteria.The VITEK automated microbial analyzer was used to identify the bacterial species.A total of 3342 non-repetitive Klebsiella pneumoniae isolates were obtained during this period.Each Klebsiella pneumoniae strain was subjected to drug susceptibility testing using automated antimicrobial systems,disk diffusion methods,or standard broth microdilution methods to determine the antibiotic resistance profiles of Klebsiella pneumoniae.The detection rate of Klebsiella pneumoniae in clinical specimens and its association with specimen sources or department categories were analyzed.Results Klebsiella pneumoniae isolates were obtained from sputum(42.07%),urine(14.81%),and blood(10.29%).The departments with higher detection rates of Klebsiella pneumoniae were Intensive Care Unit(ICU)(35.19%),Neurosurgery(6.28%),and Respiratory and Critical Care Medicine(5.42%).The resistance identification results showed the highest resistance rate to ampicillin(100.00%)and the lowest resistance rate to amikacin(4.22%).Annual analysis of resistance rates to carbapenems in Klebsiella pneumoniae isolates from 2018 to 2021 revealed an increasing trend:2.94%,4.66%,7.90%,and 15.35%,respectively.However,in 2022,the resistance rate started to decrease(5.38%).Carbapenem-resistant Klebsiella pneumoniae strains were predominantly of the KPC type,and there was a statistically significant difference in the resistance rates to commonly used antimicrobial drugs between carbapenem-resistant Klebsiella pneumoniae and carbapenem-sensitive Klebsiella pneumoniae(P<0.01).Conclusion Klebsiella pneumoniae maintains a high level of clinical isolation rate,along with high resistance rates.Therefore,it is necessary to strengthen the prevention and control of hospital-acquired bacterial infections and surveillance of drug resistance.Rational selection of antimicrobial drugs should be employed for the treatment of Klebsiella pneumoniae infections.