肺炎克雷伯菌临床分布特点及耐药性监测分析
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摘要
目的:分析肺炎克雷伯菌的临床分布及细菌耐药情况,为临床合理使用抗菌药物、降低细菌耐药率及控制医院感染提供指导依据。方法:回顾性分析我院2015～2017年临床各种标本分离出的2 107株肺炎克雷伯菌的临床科室分布、标本来源以及耐药情况。结果:共检出肺炎克雷伯菌2 107株,标本检出最高的是痰1 232株,占58. 47%,其次分别为尿液386株(18. 32%)、全血142株(6. 74%);科室分布主要在重症医学科519株,占24. 63%,其次分别在呼吸内科194株(9. 21%)和泌尿外科179株(8. 50%);肺炎克雷伯菌对大多数抗菌药物耐药,且呈逐年上升趋势。2017年肺炎克雷伯菌对氨苄西林耐药率高达100%,对氨曲南、复方新诺明、庆大霉素、头孢唑林等的耐药率> 30%;其余阿米卡星、哌拉西林/他唑巴坦、亚胺培南等较前两年相比有所降低,而头孢哌酮/舒巴坦和头孢曲松为敏感药物,耐药率为0。结论:肺炎克雷伯菌对常用抗菌药物耐药广泛,且耐药率较高,应加强对其耐药性的监测,减少耐药菌株的产生,指导临床正确且合理使用抗菌药物。
Objective: The clinical distribution and drug resistance of klebsiella pneumoniae were analyzed to provide guidance for rational use of antibiotics,reduction of drug resistance rate and control of nosocomial infection. Methods:Retrospective analysis of the clinical department distribution,sample source and drug resistance of 2107 strains of klebsiella pneumoniae isolated from various clinical specimens from 2015 to 2017. Results: A total of 2 107 strains of klebsiella pneumoniae were detected,the highest of which was 1 232 strains of sputum( 58. 47%),followed by 386 strains of urine( 18. 32%) and 142 strains of whole blood( 6. 74%). The departments were mainly distributed in the intensive care unit( ICU),accounting for 24. 63%,followed by 194( 9. 21%) in the respiratory department and 179( 8. 50%)in the urology department. Klebsiella pneumoniae was resistant to most antibiotics,and the trend was increasing year by year. In 2017,the drug resistance rate of klebsiella pneumoniae to ampicillin was as high as 100%,and that of triamcinolone,compound xinnomin and gentamicin cefazolin was > 30%. The remaining amikacin,piperacillin/tazobactam imipenem,etc. were decreased compared with the previous two years,while cefoperazone/sulbactam and ceftriaxone were sensitive drugs with drug resistance rate of 0. Conclusions: Klebsiella pneumoniae is widely resistant to commonly used antibiotics,and the drug resistance rate is high. Therefore,it is necessary to strengthen the monitoring of drug resistance,reduce the generation of drug-resistant strains,and guide the correct and rational use of antibiotics clinically.
Objective: The clinical distribution and drug resistance of klebsiella pneumoniae were analyzed to provide guidance for rational use of antibiotics,reduction of drug resistance rate and control of nosocomial infection. Methods:Retrospective analysis of the clinical department distribution,sample source and drug resistance of 2107 strains of klebsiella pneumoniae isolated from various clinical specimens from 2015 to 2017. Results: A total of 2 107 strains of klebsiella pneumoniae were detected,the highest of which was 1 232 strains of sputum( 58. 47%),followed by 386 strains of urine( 18. 32%) and 142 strains of whole blood( 6. 74%). The departments were mainly distributed in the intensive care unit( ICU),accounting for 24. 63%,followed by 194( 9. 21%) in the respiratory department and 179( 8. 50%)in the urology department. Klebsiella pneumoniae was resistant to most antibiotics,and the trend was increasing year by year. In 2017,the drug resistance rate of klebsiella pneumoniae to ampicillin was as high as 100%,and that of triamcinolone,compound xinnomin and gentamicin cefazolin was > 30%. The remaining amikacin,piperacillin/tazobactam imipenem,etc. were decreased compared with the previous two years,while cefoperazone/sulbactam and ceftriaxone were sensitive drugs with drug resistance rate of 0. Conclusions: Klebsiella pneumoniae is widely resistant to commonly used antibiotics,and the drug resistance rate is high. Therefore,it is necessary to strengthen the monitoring of drug resistance,reduce the generation of drug-resistant strains,and guide the correct and rational use of antibiotics clinically.
引文
[1]聂立岩,靳雪,张强.2010~2015年肺炎克雷伯菌临床分布及耐药性分析[J].当代医学,2017,23(6):83-85.
[2]李永伟,许晓娜,王志盛,等.郑州市耐碳青霉烯类肺炎克雷伯菌耐药趋势分析[J].中华医院感染学杂志,2018,28(21):3207-3210.
[3]陈晓宇.我院患者肺炎克雷伯菌感染分布及耐药性分析[J].江西医药,2018,53(8):845-846.
[4]刘兆玮,李伟,曹娜.2015~2017年某院大肠埃希菌与肺炎克雷伯菌的临床分布及耐药性监测[J].现代预防医学,2018,45(18):3393-3396.
[5]钮学敏,张晓祥,成宇,等.2012~2015年肺炎克雷伯菌的临床分布及耐药性趋势分析[J].中国高等医学教育,2017,2(10):128-129.
[6]曾倩倩,袁喆.肺炎克雷伯菌3276株耐药性监测分析[J].西部医学,2017,29(12):1698-1701.
[7]林雪峰,江丹英,王兵勇,等.连续10年的肺炎克雷伯菌耐药性变迁调查[J].中国乡村医药,2016,23(12):71-73.
[8]邹红,李剑鸿,陈果,等.某院不同标本来源的肺炎克雷伯菌耐药性分析[J].检验医学与临床,2018,15(20):3073-3075.
[9]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[10]Sotgiu G,Are BM,Pesapane L,et al.Nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae in an Italian university hospital:a molrcular epidemiological study[J].J Hosp Infect,2018,99(4):413-418.
[11]Tang H J,Lai C C,Chen C C,et al.Colistin-sparing regimens against Klebsiella pneumoniae carbapenemaseproducing K.pneumoniae isolates:Combination of tigecycline or doxycyline and gentamicin or amikacin[J].JMicrobiology Immunol Infect,2016,10(3):S16842.
[12]师志云,刘香花,李刚,等.临床分离大肠埃希菌和肺炎克雷伯菌耐药性变迁[J].检验医学与临床,2018,15(22):3349-3352.
[2]李永伟,许晓娜,王志盛,等.郑州市耐碳青霉烯类肺炎克雷伯菌耐药趋势分析[J].中华医院感染学杂志,2018,28(21):3207-3210.
[3]陈晓宇.我院患者肺炎克雷伯菌感染分布及耐药性分析[J].江西医药,2018,53(8):845-846.
[4]刘兆玮,李伟,曹娜.2015~2017年某院大肠埃希菌与肺炎克雷伯菌的临床分布及耐药性监测[J].现代预防医学,2018,45(18):3393-3396.
[5]钮学敏,张晓祥,成宇,等.2012~2015年肺炎克雷伯菌的临床分布及耐药性趋势分析[J].中国高等医学教育,2017,2(10):128-129.
[6]曾倩倩,袁喆.肺炎克雷伯菌3276株耐药性监测分析[J].西部医学,2017,29(12):1698-1701.
[7]林雪峰,江丹英,王兵勇,等.连续10年的肺炎克雷伯菌耐药性变迁调查[J].中国乡村医药,2016,23(12):71-73.
[8]邹红,李剑鸿,陈果,等.某院不同标本来源的肺炎克雷伯菌耐药性分析[J].检验医学与临床,2018,15(20):3073-3075.
[9]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[10]Sotgiu G,Are BM,Pesapane L,et al.Nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae in an Italian university hospital:a molrcular epidemiological study[J].J Hosp Infect,2018,99(4):413-418.
[11]Tang H J,Lai C C,Chen C C,et al.Colistin-sparing regimens against Klebsiella pneumoniae carbapenemaseproducing K.pneumoniae isolates:Combination of tigecycline or doxycyline and gentamicin or amikacin[J].JMicrobiology Immunol Infect,2016,10(3):S16842.
[12]师志云,刘香花,李刚,等.临床分离大肠埃希菌和肺炎克雷伯菌耐药性变迁[J].检验医学与临床,2018,15(22):3349-3352.
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