2012—2023年某医院耐碳青霉烯类肺炎克雷伯菌感染流行特征分析

Epidemic characteristics of carbapenem resistant Klebsiella pneumoniae infection in a certain hospital from 2012 to 2023

目的调查分析某医院临床送检标本耐碳青霉烯类肺炎克雷伯菌(CRKP)的检出情况及其相关临床特征,为合理用药和防控CRKP医院感染提供依据。方法采用回顾性调查方法,收集2012—2023年该医院各临床科室患者临床标本分离的肺炎克雷伯菌资料;比较不同来源、不同科室和不同类型患者CRKP检出情况,并分析病原菌耐药性变化。结果非血流感染组CRKP检出率高于血流感染组(11.2%vs 7.9%;χ^(2)=11.534,P=0.001);血液、痰、支气管肺泡灌洗液、尿液和脑脊液的CRKP检出率随年份变化呈总体上升趋势(P<0.05)。ICU的CRKP检出率高于非ICU(16.1%vs 8.9%;χ^(2)=100.564,P<0.001);成年组和老年组CRKP检出率呈总体上升趋势(Z=10.105和12.107,P<0.05),新生儿组则呈下降趋势(Z=-2.099,P=0.036)。CRKP对头孢他啶、头孢曲松、头孢唑啉、厄他培南和氨苄西林/舒巴坦呈高耐药,耐药率均>95%。结论医院应加强对重要类型标本、重点病区和特殊人群的有效监测,规范抗菌药物的合理使用。

Objective To investigate and analyze the detection rate of carbapenem-resistant Klebsiella pneumoniae(CRKP)in clinical specimens of a hospital and its related clinical characteristics,so as to provide a basis for rational medicine use and prevention and control of CRKP nosocomial infection.Methods A retrospective investigation method was used to collect the data of Klebsiella pneumoniae isolated from clinical specimens of patients in clinical departments from 2012 to 2023.The CRKP detection was compared from different sources,departments and types of patients,and the changes of pathogen resistance were analyzed.Results The detection rate of CRKP in the non-bloodstream infection group was higher than that in the bloodstream infection group(11.2%vs 7.9%;χ^(2)=11.534,P=0.001).The detection rates of CRKP in blood,sputum,bronchoalveolar lavage fluid,urine,and cerebrospinal fluid showed an overall rising trend over time(P<0.05).The detection rate of CRKP in ICU was higher than that in non-ICU(16.1%vs 8.9%;χ^(2)=100.564,P<0.001).The detection rates of CRKP in the adult group and the elderly group showed an overall upward trend(Z=10.105 and 12.107,P<0.05),while the neonatal group showed a downward trend(Z=-2.099,P=0.036).CRKP exhibited high resistance to ceftazidime,ceftriaxone,cefazolin,ertapenem,and ampicillin/sulbactam,with drug resistance rates exceeding 95%.Conclusion Hospitals should strengthen the effective monitoring of important types of specimens,key wards and special groups,and standardize the rational use of antibiotics.