| 刘炉香,全晶晶,吕娇健,徐欢,李晨.某院2011-2017年产气克雷伯菌临床分布及耐药性变迁[J].浙江中西医结合杂志,2022,32(6): |
| 某院2011-2017年产气克雷伯菌临床分布及耐药性变迁 |
| Clinical distribution and change in antibiotic resistance of Klebsiella aerogenes in a hospital during 2011-2017Liu Luxiang, Quan Jingjing, Lv Jiaojian, Xu Huan, Li Chen |
| 投稿时间：2021-10-17 修订日期：2022-04-26 |
| DOI： |
| 中文关键词: 产气克雷伯菌 耐药趋势 碳青霉烯类抗菌药物 |
| 英文关键词:Klebsiella aerogenes resistance trend carbapenems |
| 基金项目:浙江省丽水市科技计划项目(No.2020SJZC035) |
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| 中文摘要: |
| 摘要：目的：分析产气克雷伯菌的临床分离情况及对常见抗菌药物的耐药性，为临床抗菌药物抗菌药物合理选择提供依据。方法：选取浙江省某三甲医院连续保存的2011-2017年期间（其中2014年遗失）所有产气克雷伯菌共364株，分析其临床分布特征；微量肉汤稀释法测定常见抗菌药物最低抑菌浓度（Minimum inhibitory concentrations, MICs），分析耐药率及耐药趋势。结果：菌株来源部位前三位：痰液，血液，尿液；科室分布前三位：神经外科，ICU，普外科。364株产气克雷伯菌，碳青霉烯类抗菌药物的总体耐药率为5.5%，厄他培南、美罗培南及亚胺培南的耐药率分别为5.2%、3.0%、3.3%；头孢曲松的耐药率最高，为47.8%，头孢吡肟的耐药率为21.7%，哌拉西林/他唑巴坦及头孢哌酮/舒巴坦的耐药率分别为11.8%、18.1%，左氧氟沙星的耐药率为28.6%，阿米卡星和替加环素的耐药率分别为3.3%和7.1%。耐药趋势上看，2011-2017年期间，碳青霉烯类抗菌药物的耐药率保持稳定，均＜8%，头孢曲松的耐药率维持在40-60%之间（除外2012年），头孢吡肟的耐药率维持在20%左右，酶抑制剂的耐药率有下降趋势，从2012年开始，左氧氟沙星的耐药率有增高趋势。阿米卡星、替加环素的耐药率较低，耐药趋势稳定。结论：产气克雷伯菌是医院感染的重要病原体之一，应该引起重视；当出现产气克雷伯菌感染时，临床医生应该根据患者病情轻重经验性选择氨基糖苷类、酶抑制剂、碳青霉烯类或替加环素。
关键词 产气克雷伯菌 耐药趋势 碳青霉烯类抗菌药物 |
| 英文摘要: |
| Abstract Objective This study aims to analyze the clinical distribution and the antimicrobial resistance of Klebsiella aerogenes, so as to provide a basis for the rational selection of clinical antibiotics. Methods All the K. aerogenes isolates (n=364) were obtained from 2011 to 2017 (isolates of 2014 were lost) in a tertiary hospital in Zhejiang province. Clinical distribution characteristics of the isolates were investigated. The minimal inhibitory concentrations (MICs) were performed by broth microdilution method according to the Clinical and Laboratory Standards Institute (2018). Resulsts The top three sources of these 364 isolates were sputum, blood and urine, while the top three departments were neurosurgery, ICU and general surgery. Twenty carbapenem resistant K. aerogenes (CRKA) were identified, with the rate of 5.5%(20/364). The resistance rates of ertapenem, meropenem and imipenem were 5.2%, 3.0% and 3.3%, respectively. The resistance rate of ceftriaxone was 47.8%, which was the highest among all the tested drugs. The resistance rates of cefepime, piperacillin/tazobactam and cefoperazone/sulbactam were 21.7%, 11.8% and 18.1%, respectively; The resistance rate of levofloxacin was 28.6%. The resistance rates of amikacin and tegecycline were relatively low, which were 3.3% and 7.1%, respectively. The carbapenem resistance rates were all less than 8% from 2011 to 2017. The resistance rate of ceftriaxone was maintained between 40 and 60% (except 2012), while that of cefepime was maintained at about 20%. The resistance rate of β lactam/β lactamase inhibitors showed a downward trend. Since 2012, the resistance rate of levofloxacin showed an increasing trend. The resistance rates of amikacin and tegecycline were relatively low and the trends were stable. Conclusion: K.aerogenes is one of the most important pathogens of nosocomial infections, which should be paid attention to. For clinical K.aerogenes infections, aminoglycosides, β-lactam/β-lactamase inhibitors, carbapenems and tegecycline can be recommended depending on the patients' conditions.
Key words: Klebsiella aerogenes; resistance trend; carbapenems |
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