肺炎克雷伯菌的临床分布与耐药性分析

目的分析本院2015年-2017年临床分离肺炎克雷伯菌的流行病学特点及抗菌药物耐药情况。方法对临床送检的各类标本进行常规培养,采用法国梅里埃公司的VITEK 2 Compact系统对肺炎克雷伯菌进行鉴定及药敏试验,对于仪器检测受限的抗生素选用Kirby-Bauer纸片扩散法进行补充。使用WHONET 5.6软件统计分析肺炎克雷伯菌的检出率、科室分布、标本来源及抗菌药物的耐药性变迁。结果 2015年-2017年共检出肺炎克雷伯菌613株,检出率为12.66%。ICU、眼科、泌尿外科肺炎克雷伯菌的检出率分别为10.3%、8.3%、8.2%,居临床科室前3位。送检标本中痰液标本的检出率最高,为51.4%,其次为尿标本,检出率为11.3%。3年间肺炎克雷伯菌对头孢唑啉的耐药率较高(高于50%),碳青霉烯类药物亚胺培南、美罗培南的耐药率逐年升高,氨基糖苷类、喹诺酮类药物对肺炎克雷伯菌的耐药率呈下降趋势。结论肺炎克雷伯菌对抗菌药物的耐药性不断发生变化,应加强耐药性监测,采取有效的院感防控措施,合理使用抗菌药物。

Analysis of clinical distribution and drug resistance of Klebsiella pneumoniae

Objective To analyze the epidemiological characteristics and antimicrobial resistance of clinical isolates of Klebsiella pneumoniae in our hospital from 2015 to 2017.Methods Routine culture of various specimens submitted for clinical examination,identification and drug sensitivity test of Klebsiella pneumoniae using the VITEK 2 Compact system of French Merrier,and Kirby-Bauer paper diffusion for antibiotics with limited instrument detection to supplement.The WHONET 5.6 software was used to statistically analyze the detection rate of Klebsiella pneumoniae,the distribution of departments,the source of specimens,and the changes in antimicrobial resistance.Results A total of 613 strains of Klebsiella pneumoniae were detected during2015-2017,with the detection rate of 12.66%.The detection rates of Klebsiella pneumoniae in ICU,ophthalmology and urology were 10.3%,8.3% and 8.2%,ranking in the top three clinical departments.The highest detectable rate of sputum specimens was 51.4%,followed by urine samples,with a detection rate of 11.3%.In the past three years,the resistance rate of Klebsiella pneumoniae to cefazolin was higher(more than 50%),the resistance rate of carbapenems to imipenem and meropenem increased year by year,and the resistance rate of aminoglycosides and quinolones to Klebsiella pneumoniae showed a downward trend.Conclusion The resistance of Klebsiella pneumoniae to antibiotics is changing constantly.It is necessary to strengthen the monitoring of drug resistance,take effective measures to prevent and control nosocomial infection,and rationally use antibiotics.