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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

Changes in antimicrobial resistance rates of Klebsiella pneumoniae in in-tensive care unit and comparison between Chinese and foreign databases

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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.
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)