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重症医学科肺炎克雷伯菌耐药率变迁及中外数据库对比

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目的 对比常州市第一人民医院重症医学科(简称CZFPH-ICU)和美国重症监护医疗信息库第Ⅳ版(MIMIC-Ⅳ)中肺炎克雷伯菌(KP)检出情况和耐药率,以及CZFPH-ICU中KP耐药率、耐碳青霉烯类肺炎克雷伯菌(CRKP)检出率的变迁。方法 回顾性分析2017-2019年CZFPH-ICU与MIMIC-Ⅳ中检出 KP的标本分布和耐药率差异,以及2017-2023年CZFPH-ICU KP标本分布、耐药率,不同标本来源的KP、CRKP检出率的变化趋势。结果 2017-2019年CZFPH-ICU共检出KP 2 434株,以痰标本为主;MIMIC-Ⅳ数据库中共检出KP 1 137株,以尿标本为主。与MIMIC-Ⅳ相比,CZFPH-ICU中检出的KP对常用抗菌药物均呈现出更高的耐药率。2020-2023年CZFPH-ICU共检出 KP 4 874株,仍以痰标本为主,且痰、尿、引流液和胆汁标本中CRKP的检出分别从 2017-2019 年的 17。77%、20。15%、24。22%、24。07%,下降至 2020-2023 年的 12。99%、13。56%、13。63%、8。00%(均P<0。05)。2017-2023年CZFPH-ICU分离的KP对哌拉西林/他唑巴坦、亚胺培南、美罗培南等常用抗生素的耐药率变化趋势为2017-2019年呈现上升,2020-2022年出现下降,2023年略有回升。2023年CZF-PH-ICU 分离的KP对头孢他啶/阿维巴坦、多黏菌素B及替加环素的耐药率分别为21。28%、10。22%、7。03%。结论 近7年CZFPH-ICU中KP耐药率存在缓慢下降趋势,但仍高于国外MIMIC-Ⅳ数据库中KP的耐药率。医院应加强各项感染防控措施,有效控制KP耐药和感染。
Changes in antimicrobial resistance rates of Klebsiella pneumoniae in in-tensive care unit and comparison between Chinese and foreign databases
Objective To compare the detection rates and antimicrobial resistance rates of Klebsiella pneumoniae(KP)between the intensive care unit of The First People's Hospital of Changzhou(CZFPH-ICU)and the American Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ),as well as the changes in the antimicrobial resistance rate of KP and detection rate of carbapenem-resistant KP(CRKP)in CZFPH-ICU.Methods Differences in speci-men distribution and antimicrobial resistance rate of KP detected from CZFPH-ICU and MIMIC-Ⅳ from 2017 to 2019,as well as the changing trends of specimen distribution,antimicrobial resistance rate,detection rates of KP and CRKP from different specimen sources in CZFPH-ICU from 2017 to 2023 were retrospectively analyzed.Results A total of 2 434 strains of KP were detected in CZFPH-ICU from 2017 to 2019,mainly from sputum specimens.A total of 1 137 strains of KP were detected from MIMIC-Ⅳ database,mainly from urine specimens.Compared with MIMIC-Ⅳ,KP detected from CZFPH-ICU showed higher resistance rate to commonly used antimicrobial agents.A total of 4 874 strains of KP were detected from CZFPH-ICU from 2020 to 2023,mainly from sputum specimens.The detection rates of CRKP from sputum,urine,drainage fluid and bile specimens decreased from 17.77%,20.15%,24.22%and 24.07%in 2017-2019 to 12.99%,13.56%,13.63%and 8.00%in 2020-2023,respectively(all P<0.05).The changing trend of resistance rate of KP isolated from CZFPH-ICU from 2017 to 2023 to commonly used antimicrobial agents such as piperacillin/tazobactam,imipenem,and meropenem increased in 2017-2019,decreased in 2020-2022,and slightly increased in 2023.In 2013,the resistance rates of KP isolated from CZFPH-ICU to ceftazidime/avibactam,polycolistin B and tigacycline were 21.28%,10.22%and 7.03%,respectively.Conclusion In recent 7 years,resistance rate of KP from CZFPH-ICU showed a slow decline trend,but it was still higher than that in foreign MIMIC-Ⅳ database.Hospitals should strengthen various infection prevention and control measures to ef-fectively control KP resistance and infection.

Klebsiella pneumoniaeMIMIC-Ⅳ databaseintensive care unitspecimen distributionantimicro-bial resistance change

冯诚怿、张丽伟、王洋洋、江淑芳、狄佳、樊金诺

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常州市第一人民医院感染管理处,江苏常州 213000

常州市第一人民医院微生物室,江苏常州 213000

常州市武进人民医院急诊内科,江苏常州 213000

肺炎克雷伯菌 MIMIC-Ⅳ数据库 重症医学科 标本分布 耐药率变迁

常州市卫健委科技项目

QN202355

2024

中国感染控制杂志
中南大学

中国感染控制杂志

CSTPCD北大核心
影响因子:2.112
ISSN:1671-9638
年,卷(期):2024.23(10)