2021—2023年某院耐碳青霉烯类肺炎克雷伯菌耐药性和产酶表型分析

摘要/Abstract

摘要： 目的：分析某三甲医院耐碳青霉烯类肺炎克雷伯菌（Carbapenem-Resistant Klebsiella pneumoniae，CRKP）的临床分布、耐药特点和碳青霉烯酶表型，为制定有效的CRKP控制策略提供参考。方法：回顾性分析2021—2023年某三甲医院住院患者标本中分离的非重复CRKP菌株的分布、常用抗菌药物的耐药性变迁和产酶表型。结果：2021—2023年共检出183株CRKP，主要来源于痰液（65.0%）、尿液（11.5%）和血液（10.4%）。科室分布以ICU（33.3%）为主，其次是呼吸科（24.0%）和神经外科（15.3%）。其中，神经外科构成比呈逐年下降趋势（P<0.05），而康复科构成比则呈逐年上升趋势（P<0.05）。药敏检测结果显示CRKP对β-内酰胺类、氟喹诺酮类和氨基糖苷类药物高度耐药，对替加环素、多黏菌素B和头孢他啶/阿维巴坦较敏感；对左氧氟沙星和环丙沙星的耐药率均呈上升趋势（P<0.05）。大多数CRKP产生碳青霉烯酶，以丝氨酸酶为主，其中产D类丝氨酸酶的（OXA-48）菌株呈逐年下降趋势（P<0.05）。结论：该院临床分离的CRKP菌株主要分布在ICU病房，以肺部感染最为常见。这些菌株对多数常用抗菌药物表现出较高的耐药性，主要与产丝氨酸酶有关。医院需加强重点科室的监控，优化抗菌药物的使用策略，实施精准的防控措施，以有效遏制CRKP的传播。

关键词: font-size:medium, ">肺炎克雷伯菌；临床分布；耐药性；碳青霉烯酶

Abstract: Objective： To analyze the clinical distribution， drug resistance characteristics， and carbapenemase phenotypes of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) in a Class A tertiary hospital， aiming to provide a reference for developing effective CRKP control strategies. Methods： Retrospective analysis of the distribution， antibiotic resistance changes， and enzyme phenotypes of non-repetitive CRKP strains isolated from inpatient specimens in a hospital between 2021 and 2023. Results： From 2021 to 2023， a total of 183 CRKP strains were detected， mainly from sputum (65.0%)， urine (11.5%)， and blood (10.4%). The departmental distribution was predominantly in the ICU (33.3%)， followed by the respiratory department (24.0%) and neurosurgery (15.3%). The proportion of neurosurgery shows a decreasing trend year by year (P<0.05)， while the proportion of rehabilitation medicine shows an increasing trend year by year (P<0.05). Susceptibility testing showed that CRKP was highly resistant to β-lactams， fluoroquinolones， and aminoglycosides， but more sensitive to tigecycline，polymyxin B and ceftazidime/avibactam； resistance to both levofloxacin and ciprofloxacin increased from 80.4% in 2021 to 100.0% in 2023 (P<0.05). Most CRKP produced carbapenemases， predominantly serine-type enzymes， with the proportion of strains producing class D serine carbapenemases (OXA-48) decreasing annually (P<0.05). Conclusion： The CRKP strains isolated in this hospital are predominantly found in ICU wards， with pulmonary infections being the most common. These strains exhibit high resistance to most commonly used antibiotics， primarily due to the production of serine carbapenemases. The hospital must enhance monitoring in key departments， optimize antibiotic usage strategies， and implement precise control measures to effectively curb the spread of CRKP.

Key words: font-size:medium, ">Klebsiella pneumoniae； Clinical Distribution； Resistance； Carbapenemase

中图分类号:

莫银竹1, 任宝军2, 李志伟2, 程贤雄1, 吕仕杰1, 包金颖2, 贾俊琴2, 杨焕芝1, 2. 2021—2023年某院耐碳青霉烯类肺炎克雷伯菌耐药性和产酶表型分析[J]. 中国药物评价, 2024, 41(4): 331-336.

MO Yin-zhu1, REN Bao-jun2, LI Zhi-wei2, CHENG Xian-xiong1, LV Shi-jie1, BAO Jin-ying2, JIA Jun-qin2, YANG Huan-zhi1, 2. Analysis of Carbapenem-resistant Klebsiella Pneumoniae Antibiotic Resistance and Enzyme Production Phenotype in a Hospital from 2021 to 2023[J]. CHINESE JOURNAL OF DRUG EVALUATION, 2024, 41(4): 331-336.

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