2010-2013年我院肺炎克雷伯菌感染的临床及耐药分析

发布时间：2018-04-18 03:31

本文选题：肺炎克雷伯菌 + 耐药性　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的了解2010年到2013年我院肺炎克雷伯菌感染的流行病学及临床特征，药敏及产超广谱β内酰胺酶情况，为临床抗生素的应用提供依据。方法采用回顾性分析方法，分析2010年1月至2013年12月间送检到重庆医科大学附属第一医院感染科实验室的各类标本（痰液、尿液、脓液、血液、大便、胆汁、胸腹水及创面或伤口分泌物）中分离出肺炎克雷伯菌的病例及药敏资料，用WHONET5.6及SPSS17.00软件进行数据分析。结果①流行病学及临床特点:2010-2013年我院感染科实验室共分离出肺炎克雷伯菌707株，其中男469例，女238例，男：女=1.96:1。患者最大年龄90岁，最小年龄15岁，平均年龄56±17岁，大于或等于60岁者占54.7%，其中60-69岁者125人，70岁者262人。707例患者中，肺炎克雷伯菌感染多发生于夏秋季，主要是6月份至11月份。②细菌分布:2010-2013年四年期间我院感染科实验室共检出5931株病原菌，其中肠肝菌科细菌有3711株，肺炎克雷伯菌有707株。肺炎克雷伯菌在肠杆菌科细菌的平均比例为19.1%，各年度的比例分别为20.8%、16.8%、18.7%、24.7%。临床上分离到的肺炎克雷伯菌主要来源于痰液、血液、尿液、浓液、分泌物，分别占58.8%、10.5%、8.3%、5.5%、8.2%，其中ICU有162株，占22.9%，内科病房321株，占45.4%，外科病房211株，占29.8%。③肺炎克雷伯菌产ESBLs情况:707株肺炎克雷伯菌中，产ESBLs菌株276株，阳性检出率为39.0%，各年度ESBLs的检出率分别为38.8%、36.4%、38.1%、48.9%。④药敏结果:近4年来肺炎克雷伯菌对常见抗菌药的耐药率变化如下：对氨苄西林高度耐药，，达97.3%，对哌拉西林的耐药率为40.9%，对氨苄西林/他唑巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率分别为44.8%、10.2%、12.3%。对一~四代头孢菌素的耐药率波动在30.9-51.1%间。对亚胺培南、美罗培南、头孢西丁的耐药率分别为5.9%，4.1%，13.6%。对氨基糖苷类抗菌药阿米卡星、庆大霉素的耐药率分别为7.4%，32.1%。对喹诺酮类抗菌药环丙沙星的耐药率，波动在25%左右。结论肺炎克雷伯菌的临床分离率逐年在增加，其占肠杆菌科细菌的比例及产超广谱β内酰胺酶逐年增加，这应引起重视，加强其耐药性监测，合理选择抗生素，意义重大。
[Abstract]:Objective to investigate the epidemiology and clinical characteristics of Klebsiella pneumoniae infection from 2010 to 2013 in our hospital.Methods from January 2010 to December 2013, samples (sputum, urine, pus, blood, stool, bile) from the first affiliated Hospital infection Laboratory of Chongqing Medical University were analyzed retrospectively.Cases and drug susceptibility data of Klebsiella pneumoniae isolated from pleural and abdominal effusion and wound or wound secretions were analyzed by WHONET5.6 and SPSS17.00 software.Results 1 Epidemiological and clinical characteristics of 707 strains of Klebsiella pneumoniae were isolated from the infectious laboratory of our hospital from 2010 to 2013, of which 469 were male, 238 female, 1.96: 1 male: female.The maximum age was 90 years old, the youngest age was 15 years old, the average age was 56 卤17 years old, the proportion of patients over 60 years old or equal to 60 years old was 54.7 years old. Among them, among the 262 patients aged from 60 to 69 years old, 262 patients aged 70 years old, Klebsiella pneumoniae infection occurred in summer and autumn, most of them were infected by Klebsiella pneumoniae in summer and autumn.From June to November, a total of 5931 strains of pathogenic bacteria were found in the infection laboratory of our hospital during the four years from June to November. There were 3711 strains of enterohepatic bacteria and 707 strains of Klebsiella pneumoniae.The average proportion of Klebsiella pneumoniae in Enterobacteriaceae is 19.1.The proportion of Klebsiella pneumoniae in each year is 20.8and 18.70.24.The clinical isolates of Klebsiella pneumoniae were mainly derived from sputum, blood, urine, concentrated fluid and secretions, accounting for 58.8% and 10.5% of them, respectively. There were 162 strains of ICU, accounting for 22.9%, 321 strains in internal medicine ward, and 211 strains in surgical ward.The ESBLs production of Klebsiella pneumoniae was 29.8.3%, among the strains of Klebsiella pneumoniae, 276 strains produced ESBLs.The positive rate of ESBLs in each year was 38.8% and 38.4% respectively. The results showed that the resistance rate of Klebsiella pneumoniae to common antimicrobial agents in the last 4 years was as follows: high resistance to ampicillin.The resistance rate of piperacillin to piperacillin was 40.9, and to ampicillin / tazobactam, piperacillin / tazobactam, cefoperazone / sulbactam was 44.8% and 10.2% respectively.The rate of resistance to cephalosporins of the first and fourth generations fluctuated in the range of 30.9-51.1%.The drug resistance rates of imipenem, meropenem and cefoxitin were 5.9% and 4.1% respectively.The resistance rates of amikacin and gentamicin to aminoglycosides were 7.4and 32.1respectively.The resistance rate of ciprofloxacin to quinolones was about 25%.Conclusion the clinical isolation rate of Klebsiella pneumoniae is increasing year by year, and the proportion of Klebsiella pneumoniae to Enterobacteriaceae and the production of extended-spectrum 尾 -lactamases are increasing year by year.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R517.6

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