| 摘要: |
| 目的 了解耐碳青霉烯类肺炎克雷伯菌（CRKP）的分布特点及其耐药性，为指导临床合理使用抗菌药物提供依据。方法 收集2014年1月至2017年12月临床分离的CRKP菌株，采用自动化仪器法和纸片扩散法（K-B法）对上述菌株进行药物敏感性试验，药物敏感性结果严格按照美国临床和实验室标准化协会（CLSI）和美国食品药品管理局（FDA）标准判定。采用WHONET软件和SPSS 20.0软件对数据进行统计分析。结果 共收集临床分离CRKP菌株403株，主要标本来源为痰/支气管肺泡灌洗液（169株，占41.9%）。CRKP首次分离标本来源不同，后续CRKP血流感染的发生率也不同，差异有统计学意义（P<0.05）。CRKP来源科室位列前3位的分别为烧伤重症监护病房（30.0%，121/403）、消化科（8.4%，34/403）和急诊重症监护病房（7.2%，29/403）。药物敏感性试验结果显示CRKP除对替加环素和磷霉素耐药率较低外，对其余抗生素的耐药率均>60.0%。结论 CRKP对多数常用抗生素呈现高度耐药。应加强对CRKP的耐药性监测，尤其是烧伤重症监护病房等重点科室，并采取有效措施预防和控制CRKP的传播。 |
| 关键词: 肺炎克雷伯菌 耐碳青霉烯类肺炎克雷伯菌 细菌抗药性 烧伤 重症监护病房 |
| DOI：10.16781/j.0258-879x.2019.07.0716 |
| 投稿时间：2019-02-19修订日期：2019-06-28 |
| 基金项目:国家自然科学基金青年科学基金（31500721），海军军医大学（第二军医大学）校级课题（2017QN06），上海青年临床医技人才（临床检验专业）培养资助计划（沪医卫基[2016]04号）；上海市科学技术委员会项目（17JC1400900）. |
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| Distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae isolates |
| WAN Yu-xiang,LIU Yun,LI Ya-zhou,MA Wei,HUANG Xiao-chun*,QIN Qin* |
(Department of Laboratory Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To investigate the distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates, so as to provide guidance for reasonable use of antibiotics. Methods Clinical CRKP isolates were collected in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Dec. 2017, and the antimicrobial susceptibility test was carried out using automated instrument method and Kirby-Bauer method. The results were interpreted according to the standards of America Clinical and Laboratory Standards Institute (CLSI) or America Food and Drug Administration (FDA), and the data were analyzed by WHONET 5.6 software and SPSS 20.0 software. Results A total of 403 clinical CRKP isolates were collected, and 169 (41.9%) strains of CRKP were isolated from the specimens obtained from sputum/bronchoalveolar lavage fluid. The first isolation of CRKP was from different specimens, and there was a significant difference in the incidence of CRKP blood flow infection (P<0.05). The top 3 departments in terms of isolation rates were Burn Intensive Care Unit (30.0%, 121/403), Digestive Department (8.4%, 34/403) and Emergence Intensive Care Unit (7.2%, 29/403). The antimicrobial susceptibility test showed that the drug resistance rate of the CRKP strains was more than 60.0% to all antibiotics, but tigecycline and fosfomycin. Conclusion The CRKP isolates are resistant to most commonly used antibiotics. It is necessary to strengthen the surveillance of drug resistance of CRKP isolates and take effective measures to control the spread of CRKP, especially in departments such as Burn Intensive Care Unit. |
| Key words: Klebsiella pneumoniae carbapenem-resistant Klebsiella pneumoniae bacterial drug resistance burns intensive care unit |
