摘要
目的探讨近两年来该院检验科临床送检标本产碳青霉烯酶肺炎克雷伯菌科室分布概率、类型以及对抗菌药物的耐药性等特征,为临床用药提供理论指导。方法统计分析临床送检标本分离出肺炎克雷伯菌(KP)、耐碳青霉烯肺炎克雷伯菌(CRKP)菌株的标本类型、科室分布、产碳青霉烯酶类型等特征,及对临床常见的18种抗菌药物的耐药性特征和不同类型的CRKP对氨基糖苷类药物及头孢他啶-阿维巴坦的体外药敏实验。结果从临床送检标本中共分离出1280例KP,标本类型主要是痰液50.7%(648/1280)﹑纤支镜液17.1%(219/1280)及尿液10.4%(134/1280);患者主要来自呼吸内科35.0%(453/1280),重症监护室(ICU)25.0%(325/1280);鉴定出252株CRKP菌株,各病区CRKP与该病区KP株数的比率前三位是ICU 51.7%(168/325),呼吸内科14.1%(64/453)和血液病区9.9%(25/252);非CRKP组对亚胺培南和美罗培南完全敏感,耐药率为0,CRKP组对米诺四环素、多黏菌素B、头孢他啶-阿维巴坦耐药率分别为46.0%(116/252);0.4%(1/252)及11.9%(30/252);CRKP菌株对临床常用β内酰胺类抗菌药物的耐药性均高于非CRKP组,差异有统计学意义(P<0.001);对252株CRKP组进一步分类,产丝氨酸碳青霉烯酶221株(87.7%),对头孢他啶-阿维巴坦敏感,耐药率为0.0%,对氨基糖苷类有一定的敏感性;产金属碳青霉烯酶30株(11.9%),对头孢他啶-阿维巴坦和氨基糖苷类均不敏感,耐药率为100.0%。结论CRKP对临床常用的β-内酰胺类抗菌耐药率高,对氨基糖苷类、四环素类抗菌药物有一定的敏感性,但敏感性显著低于非CRKP组。临床对CRKP的一线抗菌药物敏感性在产丝氨酸酶CRKP组和产金属酶CRKP组有所分化。酶抑制纸片法可初步鉴定CRKP类型,根据不同类型碳青霉烯酶针对性给药,对于临床用药有很好的指导意义。
Objective To explore the resistance characteristics of Carbapenemase pneumoniae in clinical specimens from our hospital in the past two years,and to provide a scientific evidence for clinical medication.Methods The characteristics of Klebsiella pneumoniae,carbapenem-resistant Klebsiella isolated from clinical specimens,including strain specimen type,carbapenemase production type,resistance to 18 most common clinical antibiotics,and their department distribution were analyzed.Results There were 1280 KP isolated from clinical specimens.The top three of positive specimens were sputum 50.7%(648/1280),fiberoptic bronchoscopy alveolar lavage 17.1%(219/1280)and urine 10.4%(134/1280).Specimens were obtained primarily from the Department of Respiratory Medicine 35%(453/1280)and Intensive Care Unit(ICU)25%(325/1280).There 252 strains of CRKP were identified.The top three ratios of the CRKP to KP were 51.7%(168/325)in ICU,14.1%(14/453)in the respiratory department and 9.9%in the hematological area(25/252),respectively.The strain of non-CRKP group was fully sensitive to Amipenem and Meropenean,whose resistance rate was 0.The resistance rate was Minotetracycline,Polymucin B,and Ceftazine-Avibatanwas 46.0%(116/252),0.4%(1/252)and 11.9%(30/252)in CRKP group,respectively.CRKP strains showed more resistance to Bendolamide antimicrobials than in non-CRKP groups,and there was statistically significant(P<0.001).The 252-strain CRKP group was further classified into Serine carbapenase strain 221(87.7%)and Metlocarbapenase strain 30(11.9%).The Serine carbapenemase strain was sensitive to ceftazine-avibattan,with a resistance rate of 0%,and some sensitivity to aminoglycosides.Metlocarbapenemase strains were insensitive to both ceftazine-Avibatan and aminoglycosides with a resistance rate of 100%.Conclusion CRKP strain has a high antimicrobial resistance toβ-endamides witch commonly used clinically,and has some sensitivity to Aminoglycosides,Tetracycline antimicrobial drugs,but has a significantly lower sensitivity than in the non-CRKP group.There was a different sensitivity for first-line antimicrobial agents between in Serine carbapenemase strain and Metlocarbapenemase strains.The method of enzymatic inhibition paper can be the preliminary identification of CRKP type,therefore,according to different types of carbapenemase targeted administration,which has a good guiding significance for clinical drug use.
作者
张峻梅
杨莉莉
冯小艳
刘敏
杨菊艳
彭溪
李霜
ZHANG Junmei;YANG Lili;FENG Xiaoyan;LIU Min;YANG Juyan;PENG Xi;LI Shuang(Laboratory Department,Chengdu Third People′s Hospital,Chengdu,Sichuan 610014,China)
出处
《国际检验医学杂志》
CAS
2023年第S02期108-113,共6页
International Journal of Laboratory Medicine
关键词
肺炎克雷伯菌
耐碳青霉烯类
耐药
药物敏感性
Klebsiella pneumoniae
carbapenem-resistant
drug resistance
drug sensitivity
