肺炎克雷伯菌的分布及耐药性分析
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摘要
目的了解医院肺炎克雷伯菌的分布及耐药特点,为临床治疗相关感染提供依据。方法对本院2017年1月-12月227株肺炎克雷伯菌(KPN)的分布及耐药情况进行回顾性分析;使用西门子MicroScan walkAway-96细菌鉴定及药敏分析系统进行细菌鉴定和药敏试验;按照美国临床实验室标准化委员会(NCCLSI)2015年标准进行判读。结果 227株肺炎克雷伯菌主要分布在痰液和尿液中,分别占68.7%和16.7%;分离率前3位的科室分别是重症医学科、呼吸科和神经科;分别对总227株KPN、61株ICU分离株和54株神经科分离株的耐药情况进行统计分析,ICU分离株除了对替加环素和阿米卡星的耐药率较低外,对其他18种抗菌药物的耐药率均超过了50%。结论肺炎克雷伯菌是呼吸道和泌尿道感染的常见病原菌;其耐药形势不容乐观,ICU是耐药菌的重灾区,临床应加强抗菌药物的合理应用,减缓耐药菌株的出现。
Objective To understand the distribution and the drug resistance of K. pneumonias, so as to provide basis for the clinical treatment of related infection. Methods The distribution and drug resistance of 227 K. pneumonias in our hospital from January to December 2017 were retrospectively analyzed; bacterial identification and drug sensitivity were conducted by SIEMENS MicroScan walkAway-96 bacterial identification and drug sensitivity analysis system; and the results were interpreted according to the standard of National Committee for Clinical Laboratory Standard Institution(NCCLSI) in 2015. Results The 227 K. pneumonias were mainly observed in sputum and urine, accounting for 68.7% and 16.7% respectively; the top three departments with the highest separation rate were ICU, the Department of Respiration and the Neurology Department, respectively. The total resistance of 227 strains, 61 ICU strains and 54 neurologic strains were statistically analyzed respectively. The resistance rates of ICU isolates to the other 18 antimicrobial agents were over 50% except for the low drug resistance rate to tegafloxin and Amikacin. Conclusion K.pneumonias are the common pathogen in respiratory tract and urinary tract infection; its drug resistance situation is not optimistic. ICU is the heavy disaster area of drug resistant bacteria. The rational application of antibiotics should be strengthened in clinical practice to slow down the emergence of drug-resistant strains.
Objective To understand the distribution and the drug resistance of K. pneumonias, so as to provide basis for the clinical treatment of related infection. Methods The distribution and drug resistance of 227 K. pneumonias in our hospital from January to December 2017 were retrospectively analyzed; bacterial identification and drug sensitivity were conducted by SIEMENS MicroScan walkAway-96 bacterial identification and drug sensitivity analysis system; and the results were interpreted according to the standard of National Committee for Clinical Laboratory Standard Institution(NCCLSI) in 2015. Results The 227 K. pneumonias were mainly observed in sputum and urine, accounting for 68.7% and 16.7% respectively; the top three departments with the highest separation rate were ICU, the Department of Respiration and the Neurology Department, respectively. The total resistance of 227 strains, 61 ICU strains and 54 neurologic strains were statistically analyzed respectively. The resistance rates of ICU isolates to the other 18 antimicrobial agents were over 50% except for the low drug resistance rate to tegafloxin and Amikacin. Conclusion K.pneumonias are the common pathogen in respiratory tract and urinary tract infection; its drug resistance situation is not optimistic. ICU is the heavy disaster area of drug resistant bacteria. The rational application of antibiotics should be strengthened in clinical practice to slow down the emergence of drug-resistant strains.
引文
[1] 王辉. 临床微生物学手册[M]. 11版. 北京: 中华医学电子音像出版社, 2017: 903.
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[3] 詹玲玲, 陈约慧, 陈舒彤, 等. 综合性医院ICU、NSICU、CCU和RICU分离的肺炎克雷伯菌临床分布和耐药谱分析[J]. 中国卫生检验杂志, 2018, 28(1): 44-46.
[4] 邓晓丽, 李明. 2010年-2013年医院感染病原学分析[J]. 中国卫生检验杂志, 2014, 24(12):1804-1806.
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[7] 赵书平,姜梅杰,宗桂珍.检测KPC型碳氢酶烯酶肺炎克雷伯菌常用药物敏感试验方法的比较[J]. 中华实验和临床感染病杂志: 电子版, 2012, 6(2): 93-96.
[8] 韩艳, 陈丽萍, 李智伟. 肺炎克雷伯军耐药分布及KPC-2耐药基因研究[J]. 中国卫生检验杂志, 2014, 24(3): 435-440.
[9] 陈杨, 俞松山, 胡庆丰, 等. 69株碳青霉烯类耐药肺炎克雷伯菌耐药基因检测分析[J]. 中国卫生产业, 2013, 1(10): 28-30.
[10] 关红, 曹霞, 陈蕊, 等. 对碳青霉烯类抗生素敏感性降低的肺炎克雷伯菌耐药机理探讨[J]. 四川大学学报: 医学版, 2013: 44(2): 242-245.
[11] 吴伟清, 油丽萍, 徐茶, 等. 碳氢酶烯类耐药肠杆菌科细菌的β-内酰胺酶耐药基因的研究[J]. 中国卫生检验杂志, 2015, 25(11): 1856-1859.
[12] 汪琴琴, 金秀萍, 杜蓬. 产ESBLs肺炎克雷伯菌临床菌株耐药性及基因型分析[J]. 中国卫生检验杂志, 2014, 24(6): 890-892.
[13] 刘艳洁, 高鹏. 耐碳氢酶烯类肠杆菌科细菌的分布及耐药性分析[J]. 中国卫生检验杂志, 2017, 27(24): 3642-3646.
[14] 章白苓, 桂炳东, 胡晓彦, 等. 多重耐药鲍曼不动杆菌对替加环素等15种抗菌药物的耐药性分析[J]. 临床检验杂志,2011, 29(7): 553-555.
[15] Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study[J]. Lancet Infect Dis, 2010, 10(9): 597-612.
[2] Clinical and Laboratory Standards Institute performance standards for antimicrobial susceptibility testing: Twenty-fifth Informational Supplement[S]. M100-S25.CLSI, Wayne, PA, USA, 2015.
[3] 詹玲玲, 陈约慧, 陈舒彤, 等. 综合性医院ICU、NSICU、CCU和RICU分离的肺炎克雷伯菌临床分布和耐药谱分析[J]. 中国卫生检验杂志, 2018, 28(1): 44-46.
[4] 邓晓丽, 李明. 2010年-2013年医院感染病原学分析[J]. 中国卫生检验杂志, 2014, 24(12):1804-1806.
[5] Brisse S, Fevre C, Passet V, et al. Virulent clones of Klebsiella pneumoniae:identification and evolutionary scenario based on genomic and phenotypic characterization[J]. PLoS One, 2009, 4(3): e4982.
[6] 张弘,张春玲,徐德祥,等.肺炎克雷伯杆菌对抗菌药物耐药性变化的影响[J]. 现代生物医学进展, 2015, 2(15): 328-331.
[7] 赵书平,姜梅杰,宗桂珍.检测KPC型碳氢酶烯酶肺炎克雷伯菌常用药物敏感试验方法的比较[J]. 中华实验和临床感染病杂志: 电子版, 2012, 6(2): 93-96.
[8] 韩艳, 陈丽萍, 李智伟. 肺炎克雷伯军耐药分布及KPC-2耐药基因研究[J]. 中国卫生检验杂志, 2014, 24(3): 435-440.
[9] 陈杨, 俞松山, 胡庆丰, 等. 69株碳青霉烯类耐药肺炎克雷伯菌耐药基因检测分析[J]. 中国卫生产业, 2013, 1(10): 28-30.
[10] 关红, 曹霞, 陈蕊, 等. 对碳青霉烯类抗生素敏感性降低的肺炎克雷伯菌耐药机理探讨[J]. 四川大学学报: 医学版, 2013: 44(2): 242-245.
[11] 吴伟清, 油丽萍, 徐茶, 等. 碳氢酶烯类耐药肠杆菌科细菌的β-内酰胺酶耐药基因的研究[J]. 中国卫生检验杂志, 2015, 25(11): 1856-1859.
[12] 汪琴琴, 金秀萍, 杜蓬. 产ESBLs肺炎克雷伯菌临床菌株耐药性及基因型分析[J]. 中国卫生检验杂志, 2014, 24(6): 890-892.
[13] 刘艳洁, 高鹏. 耐碳氢酶烯类肠杆菌科细菌的分布及耐药性分析[J]. 中国卫生检验杂志, 2017, 27(24): 3642-3646.
[14] 章白苓, 桂炳东, 胡晓彦, 等. 多重耐药鲍曼不动杆菌对替加环素等15种抗菌药物的耐药性分析[J]. 临床检验杂志,2011, 29(7): 553-555.
[15] Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study[J]. Lancet Infect Dis, 2010, 10(9): 597-612.