2014-2017年某院肺炎克雷伯菌分布及耐药性分析

Distribution and drug resistance of Klebsiella pneumoniae in 2014-2017

    摘要
  • 摘要: 目的 了解中国科学技术大学附属第一医院2014年1月-2017年12月临床分离的肺炎克雷伯菌分布及耐药性分析,指导临床合理用药。方法 采用WalkAway40SI细菌分析仪进行细菌鉴定及药敏试验,PCR扩增碳青霉烯酶基因,如KPC-2、NDM-1、OXA-48、IMP、GES、VIM和SME,使用Whonet 5.5软件及SPSS 18.0进行统计数据分析。结果 四年共分离1 099株肺炎克雷伯菌,主要来自痰液(65.52%),尿液(15.83%),血液(5.92%)和脓性分泌物(4.55%)标本,在ICU、神经外科、康复科和神经内科检出率分别占25.57%、22.02%、11.83%和10.28%。2014-2017年超广谱β-内酰胺酶(ESBLs)菌株检出率分别为34.81%、38.53%、45.22%和52.33%;耐碳青霉烯类菌株检出率分别为11.60%、13.76%、14.65%和16.06%。肺炎克雷伯菌对厄他培南、亚胺培南、美罗培南和阿米卡星敏感率分别为77.07%、78.53%、76.07%和73.79%,有较高的敏感率。2017年62株耐碳青霉烯类肺炎克雷伯菌中42株为KPC-2型,以ICU和神经外科为主;7株为NDM-1型;未检出SME、IMP、OXA-48、VIM、GES阳性菌株。结论 肺炎克雷伯菌对抗菌药物的耐药率逐年递增,耐碳青霉烯类菌株在ICU和神经外科居多,应合理使用抗菌药物,及时耐药监测,防止耐药菌株传播。

     

    Abstract: OBJECTIVE To investigate the distribution and drug resistance of clinical isolates of Klebsiella pneumoniae in The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China in from Jan 2014 to Dec 2017 so as to provide guidance for reasonable clinical use of antibiotics. METHODS The strains were identified by using WalkAway40SI bacterial analyzer, the drug susceptibility testing was performed, the carbapenemase genes such as KPC-2, NDM-1, OXA-48, IMP, GES, VIM and SME were amplified by PCR, and the data were statistically analyzed with the use of Whonet 5.5 software and SPSS 18.0. RESULTS Of totally 1 099 strains of K. pneumoniae isolated in the four years, 65.52% were isolated from sputum specimens, 15.83% were isolated from urine specimens, 5.92% were isolated from blood specimens, and 4.55% were isolated from pus secretions specimnes. The isolation rate of the strains was 25.57% in ICU, 22.02% in neurosurgery department, 11.83% in rehabilitation department, 10.28% in neurology department. The isolation rate of extended-spectrum lactamases (ESBLs)-producing strains was 34.81% in 2014, 38.53% in 2015, 45.22% in 2016, 52.33% in 2017. The isolation rates of carbapenem-resistant strains were 11.60%, 13.76%, 14.65% and 16.06%, respectively. The drug susceptibility rates of the K. pneumoniae strains to ertapenem, imipenem, meropenem and amikacin were 77.07%, 78.53%, 76.07% and 73.79%, respectively. Among the 62 strains carbapenem-resistant K. pneumoniae isolated in 2017, 42 were KPC-2 type, most of which were isolated from ICU and neurosurgery department; there were 7 strains of NDM-1 type; none of the strains positive for SME, IMP, OXA-48, VIM or GES was detected. CONCLUSION The drug resistance rate of the K. pneumoniae strains is increased year by year, the carbapenem-resistant strains are dominant in ICU and neurosurgery department. It is necessary to reasonably use antibiotics and conduct the drug resistant surveillance so as to prevent the spread of drug-resistant strains.

     

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