摘要
目的了解合肥市县级综合医院耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床分布和耐药情况,为CRKP感染防控提供参考。方法采用单纯随机抽样法抽取2020~2023年合肥市3所县级综合医院微生物实验室分离的CRKP菌株,通过电子病历系统获取患者一般资料,通过中元汇吉质谱仪进行微生物鉴定,采用VITEK 2-Compact进行药敏试验,采用聚合酶链式反应(PCR)检测碳青霉烯酶基因,比较不同医院的CRKP感染患者一般资料,分析耐药率变化趋势和耐药基因构成。结果2020~2023年合肥市3所县级综合医院共收集242株CRKP,主要分布在重症医学科(44.63%),主要分离自痰标本(55.37%)。CRKP对头孢他啶和左氧氟沙星耐药率大于75%,对头孢哌酮/舒巴坦和阿米卡星耐药率呈上升趋势(P<0.05),对替加环素均敏感。CRKP携带的耐药基因以KPC型为主,占64.46%;NDM型占22.31%,OXA-48型和VIM型占比均小于5%,未检出IMP型。CRKP可同时具备两种耐药基因,KPC型+NDM型比例最高,占5.79%;KPC型+OXA-48型和NDM型+OXA-48型分别占1.24%、0.83%。结论合肥市县级综合医院CRKP对常用抗菌药物耐药形势严峻,可同时携带两种碳青霉烯酶耐药基因,其中NDM型的检出情况值得进一步关注;临床需聚焦医院内重点科室和重点人群,结合细菌耐药监测结果,合理选择抗菌药物,提高临床治疗效果。
Objective To investigate the clinical distribution and drug resistance of Klebsiella pneumoniae(CRKP)in county hospital in Hefei,so as to provide reference for the prevention and control of CRKP infection.Methods Three county-level general hospitals in Hefei were selected by simple random sampling.CRKP strains were isolated from three hospitals during 2020 to 2023.General patient information was obtained through the electronic medical record system.Microbiological identification was achieved by mass spectrometer(zybio),and the drug susceptibility test was performed by VITEK-Compact.Carbapenemase genotype was analyzed by PCR(polymerase chain reaction).The general data of patients with CRKP infection in different hospitals were compared.The trend of drug resistance rate and the composition of drug resistance genes were analyzed.Results A total of 242 strains of CRKP were isolated from 2020 to 2023.CRKP strains were mainly distributed in intensive care(44.63%),neurosurgery(18.60%)and rehabilitation department(14.46%).CRKP strains were mainly isolated from sputum(55.37%),urine(22.73%)and blood(14.88%).The drug resistance rate of CRKP to common antibiotics was more than 75%.The resistance rate to cefoperazone/sulbactam and amikacin increased(P<0.05).No strain resistant to tigacycline was detected.The main type of CRKP isolated was KPC,accounting for 64.46%.The detection rate of NDM enzyme was 22.31%,the detection rate of OXA-48 and VIM enzyme was lower than 5%,and IMP enzyme was not detected.CRKP had two kinds of drug resistance genes at the same time,and the proportion of KPC+NDM type was the highest,accounting for 5.79%;KPC+OXA-48 and NDM+OXA-48 accounted for 1.24%and 0.83%,respectively.Con⁃clusion The situation of CRKP resistance in county medical institutions was severe,and there was a large difference among different antibiotics.CRKP can carry two drug-resistant genotypes at the same time,and the enzyme detection of NDM needs further attention.Clinical focus should be on key departments and key populations within hospitals,and based on bacterial resistance monitoring results.Antibiotics should be chosen rationally to improve clinical therapeutic outcomes.
作者
杨家岭
王愿愿
庞梅
王芳
杨硕
YANG Jialing;WANG Yuanyuan;PANG Mei;WANG Fang;YANG Shuo(Department of Nosocomial Infection Management,Dongcheng District,the First Affiliated Hospital of Anhui Medical University,Hefei 231600,China;Department of Healthcare-associated Infection Management,South District,the First Affiliated Hospital of Anhui Medical University,Hefei 231200,China;Department of Healthcare-associated Infection Management,Changfeng County People’s Hospital,Hefei 231100,China;Department of Laboratory Medicine,Dong cheng District,the First Affiliated Hospital of Anhui Medical University,Hefei 231600,China)
出处
《安徽医学》
2025年第6期676-682,共7页
Anhui Medical Journal
基金
合肥市卫生健康委应用医学研究项目(编号:Hwk2022zc041)。
关键词
肺炎克雷伯菌
碳青霉烯酶
耐药监测
Klebsiella pneumoniae
Sueveillance of drug resistance
Carbapenemas
