摘要
目的:分析医院肺炎克雷伯菌(Klebsiella pneumoniae,KP)的检出情况和耐药变迁,以及其与抗菌药物使用的相关性,为临床治疗KP引发的感染提供参考。方法:收集宜春市人民医院2016年1月—2020年12月微生物培养结果为KP的住院患者的病历资料,统计KP的标本来源和历年的耐药情况,采用Spearman相关性分析法分析KP的耐药变化与抗菌药物使用的相关性。结果:2016年1月—2020年12月,医院住院患者标本中共分离出KP 1 250株,历年分离到的菌株数依次为182株、240株、272株、290株和266株,其中以从呼吸系统标本检出的数量最多(853株,占68.24%);5年间,KP对哌拉西林-他唑巴坦钠、头孢哌酮-舒巴坦钠、亚胺培南、庆大霉素、阿米卡星的耐药率始终较低(<25.00%),且对其中的哌拉西林-他唑巴坦钠、亚胺培南、庆大霉素的耐药率呈现逐年下降趋势;5年间,第2代头孢菌素、喹诺酮类、碳青霉烯类、糖肽类药物的使用频度(defined daily doses,DDDs)呈逐年增长趋势且增幅较大(>50.00%),而其中喹诺酮类、碳青霉烯类、糖肽类药物的抗菌药物使用强度(antibiotics use density,AUD)亦逐年增长且增幅较大(>50.00%);Spearman相关性分析结果显示,KP对头孢噻肟、复方磺胺甲噁唑的耐药率与单环类药物的DDDs和AUD,以及大环内酯类药物AUD呈正相关(P<0.05),而与碳青霉烯类和糖肽类药物的DDDs和AUD,以及喹诺酮类药物的AUD呈负相关(P<0.05);KP对左氧氟沙星和环丙沙星的耐药率与喹诺酮类、碳青霉烯类和糖肽类药物的DDDs和AUD均呈正相关(P<0.05),而与单环类药物DDDs和AUD,及大环内酯类药物的AUD呈负相关(P<0.05);KP对环丙沙星的耐药率还与第2代头孢菌素的DDDs、四环素类药物的AUD呈正相关(P<0.05),而与氨基糖苷类药物的DDDs和AUD呈负相关(P<0.05);KP对哌拉西林-他唑巴坦钠、头孢他啶、亚胺培南、庆大霉素的耐药率与青霉素类药物的AUD呈正相关(P<0.
Objective: To analyze the detection and the drug resistance changes of Klebsiella pneumoniae(KP) in the hospital as well as its correlation with the use of antibacterial drugs, and provide reference for clinical treatment on KP-induced infections. Methods: The medical records of inpatients with microbiological culture results of KP in Yichun People’s Hospital from January 2016 to December 2020 were collected, the sources of KP specimens and the drug resistance over the years were counted, and the correlation between drug resistance changes of KP and use of antimicrobial drugs was analyzed by Spearman correlation analysis. Results: A total of 1250 KP strains were isolated from specimens of inpatients in the hospital from January 2016 to December 2020, and the number of strains isolated over the years was182, 240, 272, 290 and 266, with the largest number detected from respiratory specimens(853 strains, accounting for68.24%). During the five years, the resistance rates of KP to piperacillin-tazobactam sodium, cefoperazone-sulbactam sodium, imipenem, gentamicin and amikacin remained low(<25.00%), and the resistance rates to piperacillin-tazobactam sodium, imipenem and gentamicin showed a decreasing trend year by year. During the five years, the defined daily doses(DDDs) of the second generation of cephalosporins, quinolones, carbapenems and glycopeptides increased year by year in a large amplitude(>50.00%), while the antibiotics use density(AUD) of quinolones, carbapenems and glycopeptides also increased year by year in a large amplitude(>50.00%). The results of Spearman correlation analysis showed that the resistance rates of KP to cefotaxime and compound sulfamethoxazole were in positive correlation to the DDDs and AUD of monocyclic drugs and AUD of macrolides(P<0.05), and in negative correlation to the DDDs and AUD of carbapenems and glycopeptides and the AUD of quinolones(P<0.05). The resistance rates of KP to levofloxacin and ciprofloxacin were in positive correlation to the DDDs and AUD of quinolones, carbap
作者
陈虎
徐荣
CHEN Hu;XU Rong(Yichun People's Hospital,Yichun,Jiangxi 336000)
出处
《抗感染药学》
2022年第4期472-476,共5页
Anti-infection Pharmacy
基金
江西省卫生健康委科技计划项目(编号:SKJP220202140)。
