医院感染和社区感染患者分离肺炎克雷伯菌的耐药性差异及变迁

目的 了解某三甲综合医院连续3年分离医院感染和社区感染肺炎克雷伯菌（KP）的分布情况及耐药性差异，为临床抗菌药物合理应用提供依据。方法 回顾性分析2016年11月—2019年10月住院患者分离的社区感染和医院感染KP，比较两组KP在不同科室、不同标本来源的构成比及耐药性差异，分析耐药变化趋势。结果 共检出KP 1 104株，其中医院感染组410株，社区感染组694株。两组KP均主要来源于痰标本，主要来源科室均为重症监护病房（ICU）。两组KP除对替加环素的耐药率均为0外，对其他抗菌药物的耐药率医院感染组均高于社区感染组（均P<0.05）。社区感染组KP对抗菌药物的耐药率均<30%，医院感染组KP对头孢曲松、复方磺胺甲口恶唑的耐药率达50%以上，对亚胺培南的耐药率为18.54%。经趋势χ²检验，医院感染组检出KP对头孢曲松、头孢吡肟、头孢西丁、头孢哌酮/舒巴坦、亚胺培南、阿米卡星、妥布霉素、左氧氟沙星和环丙沙星的耐药率均呈上升趋势，差异有统计学意义（均P<0.05）；社区感染组检出KP对哌拉西林/他唑巴坦、头孢西丁、头孢哌酮/舒巴坦、亚胺培南和环丙沙星的耐药率呈上升趋势，差异有统计学意义（均P<0.05），对庆大霉素的耐药率呈下降趋势，差异有统计学意义（P=0.004）。结论 医院感染KP耐药率高于社区感染，且医院感染组对多种抗菌药物的耐药率呈逐年上升趋势，对KP医院感染和社区感染应区别进行治疗。

Differences and changes of antimicrobial resistance of Klebsiella pneumoniae isolated from patients with healthcare-associated infection and community-associated infection

Objective To investigate the distribution and antimicrobial resistance difference of Klebsiella pneumoniae (KP) causing healthcare-associated infection (HAI) and community-associated infection (CAI) in a tertiary first-class hospital for three consecutive years, and provide evidence for rational use of antimicrobial agents in clinical practice. Methods KP isolated from hospitalized patients with CAI and HAI between November 2016 and October 2019 were retrospectively analyzed, constituent ratio and antimicrobial resistance difference of KP in different departments and different specimen sources were compared, change trend of antimicrobial resistance was analyzed. Results A total of 1 104 strains of KP were isolated, including 410 strains in HAI group and 694 in CAI group. KP in both groups were mainly isolated from sputum specimens, and the main department was intensive care unit. Except that the resistance rates of KP to tigecycline were both 0 in two groups, resistance rates to other antimicrobial agents in HAI group were all higher than those in CAI group (all P<0.05). Antimicrobial resistance rates of KP in CAI group were all <30%, resistance rates of KP to ceftriaxone and compound sulfamethoxazole in HAI group were more than 50%, resistance rate to imipenem was 18.54%. By trend χ² test, resistance rates of KP to ceftria-xone, cefepime, cefoxitin, cefoperazone/sulbactam, imipenem, amikacin, tobramycin, levofloxacin, and ciprofloxacin in HAI group all showed an upward trend (all P<0.05); resistance rates of KP to piperacillin/tazobactam, cefoxitin, cefoperazone/sulbactam, imipenem, and ciprofloxacin showed an upward trend in CAI group (all P<0.05), while resistance rate to gentamicin showed a downward trend (P=0.004). Conclusion Antimicrobial resis-tance rates of KP in HAI are higher than those in CAI, resistance rates to multiple antimicrobial agents in HAI group increase year by year, KP HAI and CAI should be treated differently.