摘要
目的分析本院耐碳青霉烯类肺炎克雷伯菌(CRKP)的感染特征及耐药情况,为临床合理用药提供依据。方法对2016-2020年该院分离的肺炎克雷伯菌(Kpn)进行细菌鉴定和药敏试验。结果2016-2020年全院共检出Kpn 4530例,检出率最高的标本来源是呼吸道,其次是尿液和血液;分布前三位的科室是重症医学科(ICU)、呼吸科和脑外科。不同年龄段人群其Kpn和CRKP构成比不同,老年人(>59岁)Kpn检出率明显大于其他各个年龄组,新生儿(0~90 d)CRKP检出率明显大于婴幼儿(>90 d至3岁)、青少年(>3~18岁)和成人(>18~59岁)。2016-2020年间全院患者对亚胺培南的耐药率(CRKP)呈稳定上升,分别为20.36%、35.95%、36.90%、44.77%和50.23%;Kpn对头孢吡肟、阿米卡星、哌拉西林/他唑巴坦的耐药率也逐年提升;对头孢替坦、头孢曲松和头孢他啶的耐药率呈小幅度波动上升;五年间Kpn对氨苄西林耐药率均为100.00%。不同标本来源的Kpn耐药谱不同,对临床12种常用抗菌药物耐药率是尿液>痰液>血液,阿米卡星和庆大霉素除外;新生儿对12种常用药物的耐药率均小于非新生儿,阿米卡星和妥布霉素除外。结论不同年龄人群、不同感染部位的肺炎克雷伯菌对临床常用药物呈不同程度耐药,临床医师应加强耐药监测,根据药敏结果合理选择抗菌药物,以提高疗效减少耐药菌株的传播和流行。
Objective To investigate the infectious characteristics and antimicrobial resistance of carbapenem-resistant Klebsiella pneumonia isolated from the second affiliated hospital of nanjing medical university and to provide the guidance for rational use of antibiotics in clinic.Methods Bacterial identification and drug sensitivity test were performed of Klebsiella pneumoniae(Kpn)isolated from the second affiliated hospital of nanjing medical university during 2016-2020.Results A total of 4,530 clinical isolates of Kpn were isolated in the second affiliated hospital of nanjing medical university from 2016 to 2020,respiratory tract specimens had the highest detection rate,followed by the urine samples and blood samples.The main departments from which Kpn strain specimens included the ICU,the respiratory department and brain surgery.The constituent ratios of Kpn and CRKP were different in different age groups,the total detection rate of Kpn in the elderly people(aged>59 years old)was significantly higher than that of other age groups.The detection rate of CRKP in neonatal(0-90 days)was significantly higher than that in infants(>90 d-3 years old),adolescents(>3-18 years old)and adults(>18-59)(P<0.05).The drug resistance rate of KPn to imipenem(CRKP)was increased steadily in the hospital from 2016 to 2020,the proportions were 20.36%,35.95%,36.90%,44.77%,and 50.23%,respectively.The resistance rates of Kpn to cefepime,amikacin,piperacillin/tazobactam were also increased year by year,the cefotetan,ceftriaxone and ceftazidine were fluctuated slightly,the drug resistance rate of ampicillin was 100%in five years.The resistant rates of Klebsiella pneumoniae isolated from different specimens were quite different,the drug resistance rate to 12 antibiotics commonly used in clinic was urine>sputum>blood,except for amikacin and gentamicin.The resistance rate of 12 drugs in neonatal was lower than that of non-neonatal,except for amikacin and tobramycin.Conclusion The Kpn which isolated from different age and different infection sites showed varying degrees of drug resistance to antimicrobial agents.Clinicians should strengthen the monitoring of drug resistance and rationally select antibiotics in combination with drug sensitivity in order to improve the efficacy and reduce the spread and prevalence of resistant strains.
作者
骆晓凤
朱叶飞
赵艳丰
胡慧敏
徐新艳
王欣慧
LUO Xiaofeng;ZHU Yefei;ZHAO Yanfeng;HU Huimin;XU Xinyan;WANG Xinhui(Laboratory Medicine Center of the Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China)
出处
《国际检验医学杂志》
CAS
2023年第S02期1-6,共6页
International Journal of Laboratory Medicine
基金
国家自然科学基金(81802071)
南京医科大学科技发展基金项目(2017NJMU031)。
关键词
耐碳青霉烯类肺炎克雷伯菌
肺炎克雷伯菌
药敏试验
不同标本
carbapenem-resistant Klebsiella pneumonia
Klebsiella pneumonia
drug sensitivity test
different specimens
作者简介
通信作者:王欣慧,E-mail:wkhui@163.com。
