目的: 分析内蒙古包头地区肺炎克雷伯菌(klebsiella pneumoniae, KP)的临床分布动态及其演化趋势。方法: 回顾性分析包头市某三甲医院2017—2024年2 532例KP的临床信息和药敏结果,分析其临床分布时间动态及其耐药性演化趋势。结果: 2017—2024年KP检出量呈波动式增长,肺炎亚种占比逐年增加(P=0.024)。季节分布上KP的不同亚种间存在差异(P＜0.001),肺炎亚种主要分布在秋季,其他亚种主要分布在春季和冬季;KP主要存在于中老年患者中(P＜0.001),在60～69岁年龄组达到最高值;普外科、呼吸科、神经内科、ICU是KP检出的主要科室(P＜0.001);主要检出标本为痰液、分泌物、尿液和静脉血。耐碳青霉烯类KP和超光谱β-内酰胺类酶KP检出率逐年增加(P＜0.001),除部分头孢类药物外,肺炎亚种对其他各抗菌药物的耐药性高于其他亚种(P＜0.001);KP对多黏菌素B耐药率较低(0.00%～0.40%),对亚胺培南和美罗培南的平均耐药率分别为4.90%和4.80%,对其他抗菌药物的耐药性整体呈逐年增加趋势(P＜0.001)。结论: 临床检出的KP逐年增加,KP在不同亚种、性别、季节、年龄、科室、样本类型中均有显著差异,多黏菌素B为最适药物,KP对其他药物的耐药性整体呈增加趋势。
Objective: To analyze the clinical distribution and evolution trend of klebsiella pneumoniae (KP) in Baotou, Inner Mongolia. Methods: Retrospective analysis of clinical data and antimicrobial susceptibility profiles of 2 532 klebsiella pneumoniae cases from a tertiary hospital in Baotou from 2017 to 2024 was conducted to investigate temporal dynamics in clinical distribution and evolutionary trends in antimicrobial resistance. Results: From 2017 to 2024, the detection rate of KP exhibited a fluctuating upward trend, accompanied by a progressive annual increase in the proportion of the pneumoniae subspecies (P=0.024). There were differences in the seasonal distribution of KP among different subspecies (P＜0.001). The subspecies of pneumonia were mainly distributed in autumn, and the other subspecies were mainly distributed in spring and winter. KP was mainly found in middle-aged and elderly patients (P＜0.001), and reached the highest value in the 60 to 69 age group. General surgery, respiratory department, neurology department and ICU were the main departments where KP was detected (P＜0.001). The main specimens were sputum, secretions, urine and venous blood. The detection rates of carbapenem-resistant klebsiella pneumoniae and hyper-spectral β-lactamase klebsiella pneumoniae increased year by year (P＜0.001). Except for some cephalosporin drugs cefazolin, the resistance of pneumonia subspecies to other antimicrobial agents was higher than that of other subspecies (P＜0.001). The resistance rate of KP to polymyxin B was low (0.00%-0.40%), and the average resistance rates to imipenem and meropenem were 4.90% and 4.80%, respectively. The resistance to other antibiotics showed an increasing trend year by year (P＜0.001). Conclusion: The clinical detection of KP increased year by year. KP was significantly different in different subspecies, gender, season, age, department and sample type. Polymyxin B was the most suitable drug. The resistance of KP to other drugs showed an increasing trend.
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