2009-2018年10 075株肺炎克雷伯菌临床分布及其耐药变迁

Change in clinical distribution and antimicrobial resistance of 10 075 strains of Klebsiella pneumoniae from 2009 to 2018

摘要:

目的 探讨肺炎克雷伯菌（KP）临床分布及其耐药变迁情况，为临床KP感染控制及其治疗提供依据。方法 回顾分析2009-2018年某院临床分离的10 075株KP，比较不同年度、不同科室、不同部位感染KP的构成情况，分析KP的耐药变化趋势。结果 KP主要来源于痰标本，是肝脓肿的主要病原菌，也是新生儿科分离的首位菌。KP的检出率由2009年的8.0%上升至2018 年的13.8%， 呈逐年上升的趋势（χ_趋势²=389.9，P<0.001）。10年间KP对亚胺培南和美罗培南的耐药率分别从 0.6%、1.5%上升至34.4%、32.8%；产ESBLs肺炎克雷伯菌检出率从18.8%上升至62.6%。综合ICU和神经内科检出的KP对亚胺培南的耐药率最高，分别从1.9%、0上升至63.7%、52.9%。血、痰、尿、腹腔引流液的耐药率分别从0、1%、0、0上升至29.3%、26.6%、34.0%、22.9%。结论 KP检出率和对抗菌药物的耐药率10年呈连续上升趋势，CRKP检出率也呈连续上升趋势，不同科室、不同感染部位存在差别。

Abstract:

Objective To investigate the change in clinical distribution and antimicrobial resistance of Klebsiella pneumoniae(KP), and provide evidence for KP infection control and treatment. Methods 10 075 strains of KP isolated from a hospital from 2009 to 2018 were analyzed retrospectively, constituent of KP in different years, different departments and different infection sites were compared, changing trend of resistance of KP was analyzed. Results KP mainly isolated from sputum specimens, which was the main pathogen of liver abscess and the most isolated pathogen from department of neonatology. Isolation rate of KP increased from 8.0% in 2009 to 13.8% in 2018, showing an upward trend year by year (χ_trend²=389.9, P<0.001). Resistance rates of KP to imipenem and meropenem increased from 0.6% and 1.5% to 34.4% and 32.8% respectively during 10 years; isolation rates of ESBLs-producing KP increased from 18.8% to 62.6%. KP isolated from general intensive care unit(ICU) and department of neurology showed the highest resistance rate to imipenem, rising from 1.9% and 0 to 63.7% and 52.9% respectively, antimicrobial resistance rates of KP from blood, sputum, urine, and abdominal drainage increased to from 0, 1%, 0, and 0 to 29.3%, 26.6%, 34.0%, and 22.9% respectively. Conclusion The isolation rate and antimicrobial resistance rate of KP showed a continuous upward trend during 10 years, isolation rate of CRKP also showed a continuous upward trend, there were differences among different departments and different infection sites.