广西医学

目的探讨2022年广西某医院临床主要分离菌的分布特点及肺炎克雷伯菌的耐药情况。方法收集2022年1—12月广西某医院住院患者的血液、痰液、尿液、分泌物等临床标本，在对其进行病原菌分离培养后开展细菌鉴定和药敏试验，分析主要分离菌的临床分布特点及肺炎克雷伯菌耐药情况。结果共分离出细菌4 349株，标本来源以清洁中段尿、痰液、伤口标本、全血、肺泡灌洗液等为主，分离菌占比较高的科室为重症医学科、呼吸与危重症医学科、移植医学中心、泌尿外科、内分泌科等。其中，革兰氏阴性菌占比为71.76%（3 121/4 349），分离率位居前5的依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌（复合群）、嗜麦芽窄食单胞菌；革兰氏阳性菌占比为28.24%（1 228/4 349），分离率位居前5的依次为金黄色葡萄球菌（复合群）、屎肠球菌、粪肠球菌、溶血葡萄球菌、表皮葡萄球菌。肺炎克雷伯菌对呋喃妥因、四环素、头孢唑啉等的耐药率较高，对替加环素、头孢他啶/阿维巴坦、多黏菌素耐药率较低。共检出91株耐碳青霉烯类肺炎克雷伯菌，主要来自康复医学科、重症医学科、移植医学中心、呼吸与危重症医学科等科室。结论肺炎克雷伯菌在临床上较为常见，其耐药形势较为严峻。临床上应加强肺炎克雷伯菌特别是耐碳青霉烯类肺炎克雷伯菌的监测，并合理使用抗菌药物，制订有针对性的预防控制措施，以避免因为耐药造成的疗效减弱。

Objective To explore the distribution characteristics of clinical main isolated bacteria and drug resistance status of Klebsiella pneumoniae in a Guangxi hospital in 2022. Methods Blood, sputum, urine, secretions, and other clinical samples of inpatients in a Guangxi hospital from January to December 2022 were collected, and after performing isolation and culture of pathogenic bacteria on them, the bacterial identification and drug sensitivity test were carried out to analyze clinical distribution characteristics of main isolated bacteria and drug resistance status of Klebsiella pneumoniae. Results A total of 4349 strains of bacteria were isolated, mainly from the samples of clean midstream urine, sputum, wound specimen, whole blood, alveolar lavage fluid, etc. The departments with high proportion of isolated bacteria were critical care medicine, respiratory and critical care medicine, transplantation medicine center, urology, and endocrinology, etc. Among which, Gram⁃negative bacteria accounted for 71.76% (3121/4349), and the top five isolation rates were Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii (complex), and Stenotrophomonas maltophilia. Gram⁃positive bacteria accounted for 28.24% (1228/4349), and the top five isolation rates were Staphylococcus aureus (complex), Enterococcus faecium, Enterococcus faecalis, Staphylococcus haemolyticus and Staphylococcus epidermidis. The drug resistance rate of Klebsiella pneumoniae to nitrofurantoin, tetracycline, cefazolin, and other medicines was relatively high, and the drug resistance rate to tigecycline, ceftazidime/avibactam, and polymyxin was low. A total of 91 strains of carbapenem⁃resistant Klebsiella pneumoniae were detected, mainly from the departments of rehabilitation medicine, critical care medicine, transplantation medicine center, and respiratory and critical care medicine, etc. Conclusion Klebsiella pneumoniae is common in clinical practice, and its drug resistance is relatively serious. In clinical practice, it is necessary to strengthen the monitoring of Klebsiella pneumoniae, especially carbapenem⁃resistant Klebsiella pneumoniae, rationally use antibiotics, and formulate targeted prevention and control measures to avoid the weakening of efficacy caused by drug resistance.