2022 年第 1 期 第 17 卷

医院2014—2020年肺炎克雷伯菌临床分布及耐药性研究

Clinical distribution and drug resistance of Klebsiella pneumoniae in the hospital from 2014 to 2020

作者：马红叶1刘哲2张蕾1孙婧婧1刘昱1雷金娥3郭利涛1

英文作者：Ma Hongye1 Liu Zhe2 Zhang Lei1 Sun Jingjing1 Liu Yu1 Lei Jin′e3 Guo Litao1

单位：1西安交通大学第一附属医院重症医学科，西安710061；2西安交通大学第一附属医院康复科，西安710061；3西安交通大学第一附属医院检验科，西安710061

英文单位：1Department of Critical Care Medicine First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710061 China; 2Department of Rehabilitation First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710061 China; 3Department of Clinical Laboratory First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710061 China

关键词：肺炎克雷伯菌；多重耐药菌；耐药性监测；重症监护病房

英文关键词：Klebsiellapneumoniae;Multi-drugresistantbacteria;Drugresistancemonitoring;Intensivecareunit

• 摘要：

• 目的 探讨2014—2020年医院肺炎克雷伯菌临床分布特征及耐药性，为临床抗菌药物合理使用提供参考。方法 收集2014年1月1日至2020年12月31日西安交通大学第一附属医院分离的非重复肺炎克雷伯菌，采用纸片扩散法或自动化仪器法进行药物敏感性试验，记录肺炎克雷伯菌检出情况、标本来源、重症监护病房（ICU）科室分布、细菌耐药性。记录产超广谱β内酰胺酶（ESBLs）肺炎克雷伯菌、耐碳青霉烯类肺炎克雷伯菌（CRKP)分离率。结果 2014—2020年全院分离肺炎克雷伯菌4 932株，各年分离率分别为8.9%（570/6 371）、9.6%（861/8 999）、9.1%（970/10 613）、8.7%（584/6 738）、8.3%（597/7 215）、8.6%（674/7 797）、9.4%（676/7 212），标本来源以痰液［28.6%（1 412/4 932）］、血液［21.5%（1 059/4 932）］、尿液［19.5%（962/4 932）］为主。ICU共分离肺炎克雷伯菌1 328株，其中肝胆外科ICU占55.3%（734/1 328）、中心ICU占30.3%（402/1 328）、呼吸ICU占12.3%（164/1 328）、心外科ICU占2.1%（28/1 328）。肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率最低，但耐药率上升幅度较大。2014—2020年全院产ESBLs肺炎克雷伯菌共分离1 753株，各年分离率呈下降的趋势；CRKP共分离309株，各年分离率呈上升趋势。ICU产ESBLs肺炎克雷伯菌对哌拉西林他唑巴坦的耐药率高于全院（13.0%比8.6%，P＜0.05），对亚胺培南、美罗培南的耐药率与全院比较差异均无统计学意义（均P＞0.05）。结论  2014—2020年本院肺炎克雷伯菌临床分离率变化不大，呼吸道、血液、泌尿系统为主要感染部位。肺炎克雷伯菌对常见抗菌药物耐药性严重，特别是对碳青霉烯类抗菌药物耐药率增长明显。

• Objective   To investigate clinical distribution characteristics and drug resistance of Klebsiella pneumoniae in the hospital from 2014 to 2020, in order to provide a reference for rational use of antibiotics in clinical practice. Methods  From January 1, 2014 to December 31, 2020, non-duplicative Klebsiella pneumoniae isolated in First Affiliated Hospital of Xi′an Jiaotong University were collected. Drug sensitivity test was conducted by Kirby-bauer method or automated instrument method. The detection of Klebsiella pneumoniae, source of samples, distribution of intensive care unit(ICU) departments and bacterial drug resistance were recorded. Isolation rates of extended spectrum β-lactamases （ESBLs）producing Klebsiella pneumoniae and carbapenem-resistant Klebsiella pneumoniae(CRKP) were recorded. Results  From 2014 to 2020, 4 932 strains of Klebsiella pneumoniae were isolated in the hospital, and the isolation rates were 8.9%（570/6 371）, 9.6%（861/8 999）, 9.1%（970/10 613）, 8.7%（584/6 738）, 8.3%（597/7 215）, 8.6%（674/7 797） and 9.4%（676/7 212） for each year. The samples were mainly derived from sputum ［28.6%（1 412/4 932）］, blood ［21.5%（1 059/4 932）］ and urine［19.5%（962/4 932）］. There were 1 328 strains of Klebsiella pneumoniae isolated from ICU, of which hepatobiliary surgery ICU accounted for 55.3%（734/1 328）, central ICU for 30.3%（402/1 328）, respiratory ICU for 12.3%（164/1 328） and cardiac surgery ICU for 2.1%（28/1 328）. The drug resistance rate of Klebsiella pneumoniae to carbapenems was the lowest, but the drug resistance rate increased significantly. From 2014 to 2020, 1 753 strains of ESBLs producing Klebsiella pneumoniae were isolated in the hospital, with a downward trend in isolation rate for each year; 309 strains of CRKP were isolated in the hospital, with an upward trend in isolation rate for each year. The drug resistance rate of ESBLs producing Klebsiella pneumoniae to piperacillin tazobactam in ICU was higher than that in the hospital(13.0% vs 8.6%, P<0.05), and there were no significant differences in drug resistance rates to imipenem and meropenem between ICU and the hospital (both P>0.05). Conclusions  The clinical isolation rate of Klebsiella pneumoniae in the hospital has little change from 2014 to 2020. Respiratory tract, blood and urinary system are the main infection sites. Klebsiella pneumoniae has serious drug resistance to common antibiotics. In particular, drug resistance rate to carbapenems has grown significantly.