西双版纳地区2013-2022年肺炎克雷伯菌的临床耐药性分析

Clinical Distribution and Drug Resistance Analysis of Klebsiella Pneumoniae in Xishuangbanna Area from 2013 to 2022

目的:分析2013–2022年西双版纳地区肺炎克雷伯菌的临床分布及耐药性情况。方法:选取2013年1月至2022年12月西双版纳傣族自治州人民医院临床送检尿液、痰液、血液和分泌物等分离的5117株菌株,对肺炎克雷伯菌分布情况、耐药性进行回顾分析。结果:研究期间共检出肺炎克雷伯菌5117株,检出比重最多的标本类型是痰液,共3886株,占比75.90%,伤口分泌物、尿液、血液、脓液、关节腔积液中的检出率呈现逐年上升趋势。耐药性方面,2013–2016年间肺炎克雷伯菌对哌拉西林、阿莫西林/克拉维酸、头孢哌酮/舒巴坦、头孢他啶、哌拉西林/他唑巴坦的耐药率逐年升高,2017年有所降低,2018–2020年耐药性逐渐升高,且其2018–2020年的耐药性均高于2017年,2021年下降,2022年又升高。从2013–2019年,肺炎克雷伯菌对氨曲南、美罗培南耐药率基本呈逐渐升高趋势,2020年,氨曲南耐药性开始下降。2013–2018年间头孢吡肟耐药率逐年升高,2019–2022年与2018年相比耐药率有所下降。耐药率最低药物为替加环素,其次为阿米卡星。结论:2013–2022年期间,西双版纳地区的肺炎克雷伯菌导致呼吸道以外的感染呈现逐年增多趋势,耐药现象较严重但2019–2022年有所好转。临床应继续加强合理使用抗菌药物的监管,减少耐药菌株的产生和传播。

Objective To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae in Xishuangbanna area from 2013 to 2022.Methods From January 2013 to December 2022,5117 strains isolated from urine,sputum,blood and secretions from Xishuangbanna Dai Autonomous Prefecture People's Hospital were selected for retrospective analysis of the distribution and drug resistance of Klebsiella pneumoniae.Results A total of 5117 strains of Klebsiella pneumoniae were detected during the study,and the sputum with the highest proportion was 3886 strains,accounting for 75.90%.The detection rate of wound secretions,urine,blood,pus and joint effusion showed an increasing trend year by year.In terms of drug resistance,the resistance rate of Klebsiella pneumoniae to piperacillin,amoxicillin/clavulanate,cefoperazone/sulbactam,ceftazobacillin/piperacillin/tazobactam increased year by year from 2013 to 2016,decreased in 2017,and gradually increased from 2018 to 2020.The resistance in 2018-2020 was higher than that in 2017,decreased in 2021,and increased again in 2022.From 2013 to 2019,the resistance rate of Klebsiella pneumoniae to amtroenem and meropenem basically showed a gradually increasing trend,and in 2020,amtroenem resistance began to decline.The resistance rate of cefepime increased year by year from 2013 to 2018,and decreased from 2019 to 2022 compared with 2018.The lowest drug resistance rate was tigecycline,followed by amikacin.Conclusion From 2013 to 2022,Klebsiella pneumoniae in Xishuangbanna area caused an increasing trend of infections outside the respiratory tract year by year,and the phenomenon of drug resistance was relatively serious,but it improved in 2019-2022.Clinical supervision of rational use of antibiotics should continue to be strengthened to reduce the generation and spread of drug-resistant strains.