重症医学科肺炎克雷伯菌耐药率变迁及中外数据库对比

Changes in antimicrobial resistance rates of Klebsiella pneumoniae in intensive care unit and comparison between Chinese and foreign databases

摘要:

目的 对比常州市第一人民医院重症医学科(简称CZFPH-ICU)和美国重症监护医疗信息库第Ⅳ版(MIMIC-Ⅳ)中肺炎克雷伯菌(KP)检出情况和耐药率,以及CZFPH-ICU中KP耐药率、耐碳青霉烯类肺炎克雷伯菌(CRKP)检出率的变迁。方法 回顾性分析2017—2019年CZFPH-ICU与MIMIC-Ⅳ中检出KP的标本分布和耐药率差异,以及2017—2023年CZFPH-ICU KP标本分布、耐药率,不同标本来源的KP、CRKP检出率的变化趋势。结果 2017—2019年CZFPH-ICU共检出KP 2 434株,以痰标本为主;MIMIC-Ⅳ数据库中共检出KP 1 137株,以尿标本为主。与MIMIC-Ⅳ相比,CZFPH-ICU中检出的KP对常用抗菌药物均呈现出更高的耐药率。2020—2023年CZFPH-ICU共检出KP 4 874株,仍以痰标本为主,且痰、尿、引流液和胆汁标本中CRKP的检出分别从2017—2019年的17.77%、20.15%、24.22%、24.07%,下降至2020—2023年的12.99%、13.56%、13.63%、8.00%(均P＜0.05)。2017—2023年CZFPH-ICU分离的KP对哌拉西林/他唑巴坦、亚胺培南、美罗培南等常用抗生素的耐药率变化趋势为2017—2019年呈现上升,2020—2022年出现下降,2023年略有回升。2023年CZFPH-ICU分离的KP对头孢他啶/阿维巴坦、多黏菌素B及替加环素的耐药率分别为21.28%、10.22%、7.03%。结论 近7年CZFPH-ICU中KP耐药率存在缓慢下降趋势,但仍高于国外MIMIC-Ⅳ数据库中KP的耐药率。医院应加强各项感染防控措施,有效控制KP耐药和感染。

Abstract:

Objective To compare the detection rates and antimicrobial resistance rates of Klebsiella pneumoniae (KP) between the intensive care unit of The First People’s Hospital of Changzhou (CZFPH-ICU) and the American Medical Information Mart for Intensive Care-IV (MIMIC-Ⅳ), as well as the changes in the antimicrobial resistance rate of KP and detection rate of carbapenem-resistant KP (CRKP) in CZFPH-ICU. Methods Differences in specimen distribution and antimicrobial resistance rate of KP detected from CZFPH-ICU and MIMIC-Ⅳ from 2017 to 2019, as well as the changing trends of specimen distribution, antimicrobial resistance rate, detection rates of KP and CRKP from different specimen sources in CZFPH-ICU from 2017 to 2023 were retrospectively analyzed. Results A total of 2 434 strains of KP were detected in CZFPH-ICU from 2017 to 2019, mainly from sputum specimens. A total of 1 137 strains of KP were detected from MIMIC-Ⅳ database, mainly from urine specimens. Compared with MIMIC-Ⅳ, KP detected from CZFPH-ICU showed higher resistance rate to commonly used antimicrobial agents. A total of 4 874 strains of KP were detected from CZFPH-ICU from 2020 to 2023, mainly from sputum specimens. The detection rates of CRKP from sputum, urine, drainage fluid and bile specimens decreased from 17.77%, 20.15%, 24.22% and 24.07% in 2017-2019 to 12.99%, 13.56%, 13.63% and 8.00% in 2020-2023, respectively (all P<0.05). The changing trend of resistance rate of KP isolated from CZFPH-ICU from 2017 to 2023 to commonly used antimicrobial agents such as piperacillin/tazobactam, imipenem, and meropenem increased in 2017-2019, decreased in 2020-2022, and slightly increased in 2023. In 2013, the resistance rates of KP isolated from CZFPH-ICU to ceftazidime/avibactam, polycolistin B and tigacycline were 21.28%, 10.22% and 7.03%, respectively. Conclusion In recent 7 years, resistance rate of KP from CZFPH-ICU showed a slow decline trend, but it was still higher than that in foreign MIMIC-Ⅳ database. Hospitals should strengthen various infection prevention and control measures to effectively control KP resistance and infection.