摘要
目的分析住院患者肺炎克雷伯菌(KPN)和碳青霉烯类耐药肺炎克雷伯菌(CRKP)的临床分布特点,探讨其对抗菌药物的耐药性变化趋势,为临床选择合适的抗菌药物提供依据。方法收集2018至2022年本院临床分离获得的KPN和CRKP数据,采用WHONET5.6和SPSS 25.0软件回顾性分析患者的流行病学特征、标本来源、科室分布、药物敏感性结果以及对常用抗生素的耐药性变化。结果2018至2022年共分离非重复KPN菌株5654株。标本来源为痰液(54%)、脓液(10%)、尿液(9%)。科室分布集中在重症监护室(ICU)(17%)、肝胆外科(13%)、呼吸科(10%)。KPN对头孢唑啉、美洛培南和阿米卡星的耐药率分别为21.8%、4.5%和3.5%。自2019至2021年,KPN对临床常见抗生素和碳青霉烯类抗生素耐药性呈现下降趋势。2018至2022年共分离CRKP菌株339株,检出率呈下降趋势。标本来源主要为痰液(54%)、尿液(13%)、血液(9%)。科室主要分布于ICU(40%)、重症康复(9%)、肝胆外科(8%)。CRKP对头孢菌素和其他常用的β-内酰胺类抗生素均表现出高耐药性,对阿米卡星及复方新诺明等抗菌药物表现为中等耐药,对替加环素较为敏感。该两类病原菌的感染患者主要为60岁以上的老年男性,且夏季检出率最高。结论2018至2022年该院临床分离的KPN和CRKP菌株对多数抗菌药物耐药率总体表现为先升后降趋势。定期观察细菌耐药性对了解其变化趋势至关重要,并对预防和控制CRKP的产生及传播极具意义。
Objective To analyze the clinical distribution characteristics of Klebsiella pneumoniae(KPN)and carbapenem-resistant Klebsiella pneumoniae(CRKP)in hospitalized patients,and to explore the trend of their resistance to antimicrobial agents,in order to provide a basis for the clinical selection of appropriate antimicrobial drugs.Methods Clinically isolated KPN and CRKP data from 2018 to 2022 were collected,and the epidemiological characteristics of patients,specimen sources,department distribution,drug sensitivity results,and changes in resistance to commonly used antibiotics were retrospectively analyzed using WHONET 5.6 and SPSS 25.0 software.Results A total of 5,654 non-duplicate KPN strains were isolated from 2018 to 2022.The main sources of specimens were sputum(54%),pus(10%),and urine(9%).The distribution was mainly concentrated in the intensive care unit(17%),hepatobiliary surgery(13%),and respiratory department(10%).The resistance rates of KPN to cefazolin,meropenem,and amikacin were 21.8%,4.5%,and 3.5%,respectively.From 2019 to 2021,the resistance of KPN to common clinical antibiotics and carbapenems showed a downward trend,such as imipenem and meropenem.A total of 339 CRKP strains were isolated from 2018 to 2022,with a decreasing detection rate.The main sources of specimens were sputum(54%),urine(13%),and blood(9%).The departments were mainly intensive care unit(40%),critical care rehabilitation(9%),and hepatobiliary surgery(8%).CRKP showed high resistance to cephalosporins and other commonly usedβ-lactam antibiotics,moderate resistance to amikacin and cotrimoxazole,and was more sensitive to tigecycline.Patients infected with these two types of pathogens were mainly elderly males aged≥60 years,with the highest detection rate in summer.Conclusion From 2018 to 2022,the resistance rates of KPN and CRKP strains isolated in the hospital to most antimicrobial drugs showed an overall trend of first rising and then falling.Regular observation of bacterial resistance is crucial for understanding its changing trends and is of great significance for preventing and controlling the emergence and spread of CRKP.
出处
《浙江临床医学》
2024年第11期1675-1677,共3页
Zhejiang Clinical Medical Journal
基金
浙江省嘉兴市科技计划项目(2022AD30070)。
关键词
肺炎克雷伯菌
临床分布
耐药变迁
耐药性
Klebsiella pneumoniae
Clinical distribution
Resistance changes
Resistance
作者简介
通信作者:彭佳媛。
