不同标本来源的碳青霉烯类耐药肺炎克雷伯菌临床分布及耐药性分析

Drug resistance analysis of carbapenem-resistant Klebsiella pneumoniae clinical isolates

目的了解碳青霉烯类耐药肺炎克雷伯菌(CRKP)的分布特点及耐药情况,为临床控制医院感染及合理用药提供依据。方法收集2018年1月至2020年12月温岭市第一人民医院临床标本中分离得到的907株肺炎克雷伯菌,其中295株为CRKP。对分离出的CRKP进行细菌鉴定和药敏试验,分析其临床分布的特点和耐药情况。结果临床分布分析结果表明,295株CRKP中痰标本是最常见的来源(77.0%),其次是尿液(9.5%)、脓液(5.4%)和全血(3.4%)。其中117株来自重症医学科(39.7%),其次是呼吸内科(10.9%)、康复科(8.8%)、感染科(6.4%)和神经外科(6.4%)。耐药性分析结果显示除替加环素、阿米卡星和复方新诺明耐药率低于40.0%外,其他抗菌药物的耐药率均>60.0%。结论CRKP的耐药性很高,患者主要来自重症医学科,应加强监测,优化用药策略,及时调整抗菌药物的用法、用量,降低其产生耐药的速度。

Objective To analyze the distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)clinical isolates.Methods Clinical specimens were collected for bacterial culture from patients admitted to Wenling First People's Hospital from January 2018 to December 2020.A total 907 strains of Klebsiella pneumoniae were isolated,of which 295 were carbapenem-resistant strains.The isolated CRKP strains were subjected to drug sensitivity test and further confirmed.Results The most of CRKP strains were isolated from sputum samples(227 strains,77.0%),followed by urine samples(9.5%),pus samples(5.4%),and blood samples(3.4%).Among all CRKP isolates,117 strains were from the department of critical care medicine(39.7%),followed by the department of respiratory medicine(10.9%),rehabilitation(8.8%),infection(6.4%),and neurosurgery(6.4%).Drug resistance analysis showed that the resistance rates of tigecycline,amikacin,and trimethoprim-sulfamethoxazole were less than 40.0%,and the resistance rates of other antibiotics were more than 60.0%.Conclusion This study shows that the drug resistance of CRKP is high in the hospital.It is necessary to strengthen the monitoring,optimize the medication strategy,and adjust the usage and dosage of antibiotics in time to reduce the rate of drug resistance.