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| 合肥市县级综合医院耐碳青霉烯类肺炎克雷伯菌耐药性分析及防控对策 |
| Analysis of drug resistance and control measures of carbapenem-resistant Klebsiella pneumoniae in county hospital in Hefei |
| 投稿时间：2024-09-30 修订日期：2025-02-27 |
| DOI： |
| 中文关键词: 肺炎克雷伯菌 耐药监测 碳青霉烯酶 防控对策 |
| 英文关键词: Klebsiella pneumoniae sueveillance of drug resistance Carbapenemas control measures |
| 基金项目:合肥市卫生健康委应用医学研究项目（Hwk2022zc041） |
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| 中文摘要: |
| 目的 了解合肥市县级综合医院耐碳青霉烯类肺炎克雷伯菌(CRKP)感染患者的一般资料、CRKP耐药率变化和耐药基因构成,为CRKP感染防控提供参考。方法 采用单纯随机抽样抽取合肥市3所县级综合医院,连续收集2020年至2023年3所综合性医院微生物实验室分离的CRKP菌株,通过电子病历系统获取患者一般资料,通过中元汇吉质谱仪进行微生物鉴定,采用VITEK 2-Compact进行药敏试验,采用聚合酶链式反应检测碳青霉烯酶基因,比较不同医院的CRKP感染患者一般资料,分析耐药率变化趋势和耐药基因构成。 结果 2020年至2023年共收集242株CRKP,3所医院CRKP感染患者一般资料和标本特征无差异(p＞0.05)。CRKP菌株主要分布在重症医学科(44.63%)、神经外科(18.60%)和康复科(14.46%),主要分离自痰标本(55.37%)、尿液标本(22.73%)和血液标本(14.88%)。CRKP对常用抗菌药物耐药率大于30%,对头孢哌酮/舒巴坦和阿米卡星耐药率呈上升趋势(p＜0.05),对替加环素均敏感。碳青霉烯酶基因检测以KPC型为主,占84.7%,NDM型占22.3%,OXA-48型、IMP型和VIM型占比均小于5%,同时携带两种碳青霉烯酶基因菌株占15.29%。结论 近年来,合肥市县级综合医院CRKP对常用抗菌药物耐药形式严峻,可同时携带两种碳青霉烯酶耐药基因,其中NDM型的检出情况需要进一步关注。我们需聚焦医院内重点科室和重点人群,结合细菌耐药监测结果,合理选择抗菌药物,提高临床治疗效果。 |
| 英文摘要: |
| Objective To investigate the general information on patients infected with carbapenem-resistant Klebsiella pneumoniae (CRKP),drug-resistance changes and drug resistance genotype of CRKP in County hospital in Hefei. To provide reference for the prevention and control of CRKP infection. Methods Three county-level general hospitals in Hefei were selected by simple random sampling,CRKP strains were isolated from three hospitals during 2020 to 2023.General patient information is obtained through the electronic medical record system.Microbiological identification by mass spectrometer(zybio),and the Drug susceptibility test was performed by VITEK-Compact. Carbapenemase genotype were analyzed by polymerase chain reaction. The general data of patients with CRKP infection in different hospitals were compared.The trend of drug resistance rate and the composition of drug resistance genes were analyzed.Results A total of 242 strains of CRKP were isolated from 2020 to 2023,There was no difference in the general data and specimen characteristics among the three hospitals. CRKP strains were mainly distributed in intensive care (44.63%), neurosurgery (18.60%) and rehabilitation department (14.46%).CRKP mainly isolated from sputum(55.37%), urine(22.73%) and blood (14.88%) .The drug resistance rate of CRKP to common antibiotics was more than 30%.The resistance rate to cefoperazone/sulbactam and amikacin was increased (p < 0.05).No strain resistant to tigacycline was detected.The main type of CRKP isolated were KPC,accounting for 84.7%, The detection rate of NDM enzyme was 22.3%, and the detection rate of OXA-48,VIM and IMP enzyme was lower than 5%. CRKP could carry two drug-resistant genes, accounting for 15.29%. Conclusion In recent years, the situation of CRKP resistance in county medical institutions was severe, and there was a large difference among different antibiotics.CRKP can carry two drug-resistant genotypes at the same time, and the enzyme detection of NDM needs further attention.We need to focus on key departments and key populations in the hospital.we should select antibacterial rational and improve clinical therapeutic effect combining bacterial drug resistance. |
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