2014—2018年耐碳青霉烯类肺炎克雷伯菌分离及耐药率分析#br#

目的 通过对耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)和非耐碳青霉烯类肺炎克雷伯菌的分离结果和耐药性分析，为临床提供合理治疗方案。方法 回顾性对比分析2014年1月—2018年12月分离出的284株CRKP和2272株非CRKP的标本来源、病区分布和耐药性。数据分析采用Whonet5.6统计软件，使用 SPSS 20.0软件进行差异显著性分析，耐药率比较采用χ2检验。结果 2014—2018年5年CRKP分离率分别为0、0.6%、0.2%、3.2%和26.5%，平均分离率为11.1%；病区分布主要为重症监护病房(ICU)、干部保健病房、神经内科、呼吸内科、肿瘤外科，构成比分别为33.8%、26.1%、8.8%、7.0%和4.9%。ICU的CRKP分离率明显高于非ICU(χ2=101.514, P<0.05)，二者比较差异具有显著性。CRKP标本来源主要是痰液，构成比达到48.6%。CRKP出现多重耐药，CRKP对常用的革兰阴性抗菌药物头孢菌素类、氟喹诺酮类、碳青霉烯类耐药率均超过95%，对氨基糖苷类的耐药率也超过90%；而非CRKP耐药率较低，对所有11种抗菌药物耐药率<28.6%，非CRKP对11种抗菌药物的耐药率均低于CRKP，且差异有显著性(P<0.05)。结论 CRKP分离率和耐药率较高，CRKP的耐药率明显高于非CRKP，检验科应及时报告CRKP的分离和耐药情况，加强抗菌药物的管理，强化消毒、隔离等感染控制措施。

Isolation and drug resistance analysis of carbapenem-resistant Klebsiella pneumoniae in 2014—2018#br#

Objective To provide a rational treatment plan based on the analysis of clinical isolates and drug resistance analysis of carbapenem-resistant Klebsiella pneumoniae (CRKP) and non-carbapene-like Klebsiella pneumoniae. Methods The source, ward distribution and drug resistance of 284 CRKP and 2272 non-CRKP isolates isolated from January 2014 to December 2018 were retrospectively analyzed. The Whonet 5.6 statistical software was used to perform data analysis, SPSS 20.0 software was used for differential significance analysis, and drug resistance rates were compared using χ2 test. Results The separation rates of CRKP for 5 years in 2014—2018 were 0, 0.6%, 0.2%, 3.2% and 26.5%, respectively, and the average separation rate was 11.1%; The distribution of ward was mainly intensive care unit (ICU), cadre health ward, neurology department, respiratory medicine department and tumor surgery. The composition ratios were 33.8%, 26.1%, 8.8%, 7.0% and 4.9%, respectively. The isolation rate of CRKP from the ICU ward was significantly higher than that of the non-ICU (χ2=101.514, P< 0.05), and the difference was significant. The source of CRKP specimens was mainly from sputum, with a composition ratio of 48.6%. CRKP showed multi-drug resistance. The resistance rates of CRKP to commonly used Gram-negative antibacterial drugs cephalosporins, fluoroquinolones, and carbapenems were over 95%, and the resistance rate to aminoglycosides was over 90%. The resistance rate of non-CRKP was lower than that of CRPK, and the resistance rates against all 11 antimicrobial agents were <28.6%. The resistance rates of non-CRKP to 11 antimicrobial agents were lower than those of CRKP, and the difference was significant (P<0.05). Conclusion The isolation rate and drug resistance rate of CRKP were higher than those of non-CRKP. The resistance rate of CRKP was significantly higher than that of non-CRKP. The laboratory should report the isolation and drug resistance of CRKP in time, strengthen the management of antibiotics, and strengthen the infection control measures such as disinfection and isolation.