摘要
目的了解2016—2020年琼海市人民医院肺炎克雷伯菌感染的临床特征,产超广谱β-内酰胺酶及耐碳青霉烯酶等耐药的情况,为临床抗生素应用及院内感染控制提供依据。方法采用回顾性方法,收集2016年1月—2020年12月我院微生物室各类标本中分离出的肺炎克雷伯菌的临床病例及药敏资料,采用Vitek 2-Compact自动化仪器检测法,依据CLSI 2020年标准,用WHONET 5.6软件进行数据分析。结果5年间我院微生物室共检出肺炎克雷伯菌1398株,肠杆菌科细菌占比为34.16%,主要分布来源以痰液最高,占66.52%。产ESBLs菌株阳性检出率为20.82%。近5年来肺炎克雷伯菌对常见抗菌药的耐药率变化如下:三、四代头孢耐药呈上升趋势,在2019年达高峰;哌拉西林/他唑巴坦耐药率波动在3.2%~8.8%,头孢西丁耐药率波动在12.3%~14.5%。阿米卡星耐药率呈上升趋势达1.2%。复方新诺明耐药率波动在19.4%~27.2%。碳青霉烯类耐药率从2.7%下降到1.5%。头孢哌酮/舒巴坦耐药率在3.0%~5.6%,替加环素耐药率在0.3%~0.7%。结论肺炎克雷伯菌的临床分离率逐年增加,其占肠杆菌科细菌的比例也逐年增加,虽然产超广谱β-内酰胺酶及耐碳青霉烯酶菌株在2020年检出率有所下降,但广大临床医生及院感工作者也不能忽视耐碳青霉烯酶类肺炎克雷伯菌的检出,仍要继续加强其耐药性监测,合理选择抗生素,对临床抗生素治疗具有重大的意义。
Objective To study the clinical characteristics,antimicrobial susceptibility and production of extended-spectrum β-lactamase(ESBL)of Klebsiella pneumoniae infection in Qionghai People's Hospital from 2016 to 2020,and we provide the basis for clinical antibiotic application and nosocomial infection control.Methods All Klebsiella pneumoniae isolates were retrospectively collected from January 2016 to December 2020.Antimicrobial susceptibility test was performed by Vitek 2-Compact and the data were analyzed by WHONET 5.6 software according to CLSI 2020 standard.Results In the past five years,1398 Klebsiella pneumoniae strains were isolated from various infections in our hospital,accounting for 34.16%of Enterobacteriaceae.Most of them were isolated from sputum,accounting for 66.52%.The ESBLs-producing strains accounted for 20.82%in our study.The resistance rate of Klebsiella pneumoniae to common antibiotics in the past 5 years has changed as follows:Resistance to third and fourth generation cephalosporin has been on the rise and reached its peak in 2019.The resistance rate of Piperacillin/Tazobactam fluctuated between 3.2% and 8.8%.The resistance rate of cefoxitin fluctuated between 12.3%and 14.5%.The resistance rate of amikacin increased to 1.2%.The resistance rate of compound sulfamethoxazole fluctuated between 19.4%and 27.2%.The carbapenems resistance rate decreased from 2.7%to 1.5%.The resistance rate of cefoperazone/sulbactam was 3.0%-5.6%,and the resistance rate of tigecycline was 0.3%-0.7%.Conclusion With the increasing infection rates of Klebsiella pneumoniae,ESBLs-producing Klebsiella pneumoniae strains increased year by year.Although the detection rate of ESBL and carbapenem-resistant strains decreased in 2020,it is still of great significance for clinicians and microbiologists to continue the monitoring of drug resistance pattern.
作者
王会玉
王妹妹
李洪
陈映
WANG Hui-yu;WANG Mei-mei;LI Hong;CHEN Ying(Department of Clinical laboratory,Qionghai People's Hospital,Qionghai,Hainan 571400,China)
出处
《中国热带医学》
CAS
2021年第8期769-773,共5页
China Tropical Medicine
关键词
肺炎克雷伯菌
耐药性
超广谱Β-内酰胺酶
耐碳青霉烯酶
Klebsiella pneumoniae
resistance
extended spectrumβ-lactamase
carbapenem-resistant enzyme
