Abstract:

Objective　To study the clinical distribution, drug resistance monitoring, and infection influencing factors of Klebsiella pneumoniae (KP), and to provide an important basis for the clinical diagnosis and treatment of KP infection and the rational use of appropriate antimicrobial drugs. Methods　A total of 1 852 non-repetitive KP strains isolated from specimens collected from Guangdong Second Traditional Chinese Medicine Hospital from January 2019 to December 2021 were selected. There were 1 196 males and 656 females, aged 9-103 years. The retrospective study method was used to calculate the resistance and susceptibility rates of KP according to the specimen type, patient age, and department. The clinical distribution, drug resistance, and infection related factors of KP were analyzed. χ² test and multiple logistic regression analysis were used. Results　The 1 852 clinically isolated KP strains from 2019 to 2021 accounted for 12.61% (1 852/14 691) of all isolates, ranking the third among all isolates, and showing an increasing trend in recent years. The strains were mainly isolated from the respiratory tract, urine, and blood samples. The KP strains detected in general acupuncture rehabilitation ward accounted for 38.66% (716/1 852), followed by 18.41% (341/1 852) in respiratory department and 13.71% (254/1 852) in ICU. The KP strains had high drug resistance rates to commonly used antibiotics such as penicillin and cephalosporins, and the drug resistance rates were more than 50%, showing an increasing trend year by year. As a representative drug of carbapenem antibiotics, the resistance rate to imipenem was less than 50%, showing an increasing trend in recent years. Invasive procedures (puncture, endotracheal intubation, etc.) in patients with respiratory disease, ICU admission, and use of carbapenems were risk factors for bloodstream infection caused by carbapenem resistant Klebsiella pneumoniae (CRKP) (all P<0.05). Conclusions　The detection rate of KP strains was very high, ranking the third among all isolates. There were statistically significant differences in the KP drug resistance rate among different patient age groups, specimen types, and departments. The detection rate of CRKP was very high. We should rationally use the antibiotics, strengthen the environmental monitoring, and reduce the production of drug-resistant bacteria to improve the patients' prognosis.

Key words:

Klebsiella pneumoniae, Clinical distribution, Drug resistance rate, Infection factors

摘要：

目的　研究肺炎克雷伯菌（KP）的临床分布、耐药监测及感染影响因素，为临床诊治KP感染并合理使用相应抗菌药物提供重要依据。方法　选取2019年1月至2021年12月广东省第二中医院收集标本中分离出的非重复性KP菌株1 852株。患者男1 196例，女656例，年龄9～103岁。采用回顾性研究方法将所有标本按照标本类型、患者年龄、科室分别统计KP对抗菌药物的耐药率和敏感率，分析KP的分布情况、耐药性及感染相关因素。采用χ²检验和多因素logistic回归分析。结果　2019年至2021年临床分离的1 852株KP菌株占所有分离菌株的12.61%（1 852/14 691），位列所有分离菌株第3位，且近年呈增长趋势；菌株主要来源于呼吸道、尿液、血液标本；针康病区综合检出的KP占比38.66%（716/1 852），其次是呼吸科和ICU，占比18.41%（341/1 852）、13.71%（254/1 852）。KP对常用抗生素如青霉素类、头孢菌素类均有较高耐药率，耐药率均超过50%，且呈逐年上升趋势，作为碳青霉烯类抗生素的代表药物亚胺培南，耐药率低于50%，但近几年呈逐年上升趋势。回顾发现，对呼吸道疾病患者进行侵入性操作（穿刺、气管插管等）、入住ICU和使用碳青霉烯类药物是碳青霉烯类耐药肺炎克雷伯杆菌（CRKP）引起血流感染的危险因素（均P<0.05）。结论　KP检出率所占比例很高，在所有菌种中排第3位；不同患者年龄、标本类型及科室的KP耐药率比较差异均有统计学意义；同时CRKP的检出率很高，临床应合理应用抗菌药物，加强环境监测，减少耐药菌产生，改善患者预后。

关键词:

肺炎克雷伯菌, 临床分布, 耐药率, 感染因素