2021 年第 1 期 第 16 卷

产碳青霉烯酶与非产碳青霉烯酶肺炎克雷伯菌的耐药性临床分析

Drug resistance of carbapenemase producing and non carbapenemase producing Klebsiella pneumonia

作者：马婧涵姚兴伟李慧萍张泽杨曦明

英文作者：Ma Jinghan Yao Xingwei Li Huiping Zhang Ze Yang Ximing

单位：北京中医药大学东直门医院检验科100700

英文单位：Department of Laboratory Medicine Dongzhimen Hospital Beijing University of Chinese Medicine Beijing 100700 China

关键词：肺炎克雷伯菌；耐药性；产碳青霉烯酶 

英文关键词：

• 摘要：

• 目的 探讨产碳青霉烯酶与非产碳青霉烯酶肺炎克雷伯菌的耐药情况。方法 选取2019年1—12月北京中医药大学东直门医院临床送检的标本中分离出的肺炎克雷伯菌365株，根据改良Hodge试验结果分为产碳青霉烯酶组（199株）和非产碳青霉烯酶组（166株）。分析365株肺炎克雷伯菌的标本来源和检出科室分布情况，比较产碳青霉烯酶组与非产碳青霉烯酶组肺炎克雷伯菌对临床常用18种抗菌药物的耐药率。采用WHONET 5.6软件对数据进行分析。结果 365株肺炎克雷伯菌的标本来源以痰液居首位（205株，56.2%），其次为尿液（63株，17.3%）；送检检出科室以重症监护病房居首位（157株，43.0%），其次为急诊重症监护病房（66株，18.1%）。产碳青霉烯酶肺炎克雷伯菌对氨苄西林、阿莫西林/克拉维酸、氨苄西林/舒巴坦、头孢唑林、亚胺培南和美罗培南完全耐药，对哌拉西林他/唑巴坦、头孢他啶、头孢噻肟和头胞吡肟耐药率也较高，均为99.5%（198/199）；非产碳青霉烯酶组肺炎克雷伯菌对亚胺培南和美罗培南完全敏感，耐药率均为0，对阿米卡星耐药率较低，为5.4%（9/166）。产碳青霉烯酶组肺炎克雷伯菌对临床常用β内酰胺类抗菌药物的耐药率均高于非产碳青霉烯酶组，差异均有统计学意义（均P<0.001）。结论 产碳青霉烯酶组肺炎克雷伯菌对临床常用β内酰胺类抗菌药物的耐药率均高于非产碳青霉烯酶组，产碳青霉烯酶肺炎克雷伯菌对临床常用的抗菌药物敏感性均较差，临床应合理使用抗菌药物以减少和延缓产碳青霉烯酶菌株的出现。

• Objective To investigate the drug resistance of carbapenemase producing and non carbapenemase producing Klebsiella pneumoniae. Methods Totally 365 strains of Klebsiella pneumoniae isolated from samples deceted in Dongzhimen Hospital, Beijing University of Chinese Medicine from January to December 2019 were selected. They were divided into carbapenemase producing group (199 strains) and non-carbapenemase producing group (166 strains) according to the results of modified Hodge test. The source and department distribution of 365 strains of Klebsiella pneumoniae were analyzed. The resistance rates of Klebsiella pneumoniae to 18 commonly used antibiotics were compared between carbapenease producing group and non-carbapenemase producing group. WHONET 5.6 software was used to analyze the data. Results In 365 specimens, the most clinical samples of Klebsiella pneumoniae were sputum with 205 strains (56.2%), followed by urine with 63 strains (17.3%); departments with the most Klebsiella pneumoniae detected was 157 strains (43.0%) in intensive care unit (ICU), followed by 66 strains (18.1%) in emergency ICU. Carbapenemase producing Klebsiella pneumoniae was completely resistant to ampicillin, amoxicillin/clavulanic acid, ampicillin/sodium, cefazolin, imipenem and meropenem. The drug resistance rates to piperacillin/tazobactam, ceftazidime, cefotaxime and cepepime were 99.5%(198/199). Klebsiella pneumoniae in the non-carbapenemase producing group was completely sensitive to imipenem and meropenem, and the drug resistance rates were 0. The resistance rate to amikacin was 5.4%(9/166). The resistance rates of Klebsiella pneumoniae resistant to β-lactams antibiotics commonly used in clinic in carbapenemase producing group were higher than those in non-carbapenemase producing group (all P<0.001). Conclusions  The resistance rates of Klebsiella pneumoniae in carbapenemase producing group resistant to β-lactam antibiotics commonly used in clinicwere higher than those in non-carbapenemase producing group. The sensitivity of carbapenemase producing Klebsiella pneumoniae to clinical commonly used antibiotics is poor, so antibiotics should be used reasonably in order to reduce and delay the emergence of carbapenemase producing strains.