中国西南地区3所综合性医院耐碳青霉烯类肺炎克雷伯菌流行病学特征及耐药性

Molecular epidemiological characteristics and antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae in three general hospital in southwest China

摘要:

目的 检测中国西南地区3所综合性医院耐碳青霉烯类肺炎克雷伯菌（CRKP）的流行病学特征及耐药性，为CRKP感染防控提供依据。 方法 收集2019年1-12月中国西南地区3所三级甲等医院检出的159株CRKP，采用微量肉汤稀释法检测CRKP菌株的药物敏感性，利用聚合酶链反应（PCR）进行碳青霉烯酶基因鉴定和多位点序列分型，比较患者的侵入性操作、抗菌药物使用、实验室检查和转归等临床信息。 结果 159株CRKP中，50.9%来自痰标本。94.3% CRKP感染患者接受过侵入性操作，血流感染患者病死率为66.7%。所有菌株对碳青霉烯类均不敏感，对左氧氟沙星和阿米卡星耐药率分别为85.5%、81.1%。全部CRKP菌株均检测出碳青霉烯酶基因，KPC-2检出率为86.8%。ST11是中国西南地区最流行的克隆型。 结论 中国西南地区流行的CRKP菌株表现出耐药性强的特点，血流感染患者转归和预后差，迫切需要加强感染控制措施和提高预防意识。

Abstract:

Objective To detect the epidemiological characteristics and resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) in three general hospitals in southwest China, provide basis for the prevention and control of CRKP infection. Methods 159 strains of CRKP isolated in three tertiary first class hospitals in southwest China from January to December 2019 were collected, antimicrobial susceptibility of CRKP strains was detected by micro-broth dilution method, identification and multilocus sequence typing of carbapenemase gene were carried out by polymerase chain reaction (PCR). Clinical information of patients such as invasive procedure, antimicrobial use, laboratory examination and prognosis were compared. Results 50.9% of 159 CRKP strains were from sputum specimens. 94.3% of patients with CRKP infection had received invasive procedure, mortality of patients with bloodstream infection was 66.7%. None of strains were susceptible to carbapenems, resistance rates to levofloxacin and amikacin were 85.5% and 81.1% respectively. Carbapenemase gene was detected in all CRKP strains, detection rate of KPC-2 was 86.8%. ST11 was the most prevalent clone in southwest China. Conclusion The prevalent CRKP strains in southwest China is characterized by high drug resistance, prognosis and outcome of patients with bloodstream infection is poor, it is urgent to strengthen infection control measures and improve prevention awareness.