BACKGROUND The increased prevalence of Klebsiella pneumoniae infections and resistance rates are a current cause for concern. However, data for resistance rates in K. pneumoniae strains from primary hospitals and the resistance distribution among the different isolate sample sources are scarce. METHODS All the K. pneumoniae strains were isolated from patients who visited a primary health care center located in Central Zhejiang Province from January 2011 to December 2017. The specimens included blood, sputum, cervical secretions and urine. The species were identified by the Vitek 2 Compact Bacterial Identification and Monitoring System or VITEK-MS and the extended spectrum β-lactamase (ESBL) and drug resistance profiles were identified using the AST-GN13 Gram negative susceptibility card (VITEK-2). The genotype of strains from urine sources was analyzed by detecting TEM and SHV genes. Finally, the drug resistance rates among the isolates from different sample sources were analyzed using the Chi square test with SPSS software. RESULTS A total of 5319 K. pneumoniae strains were isolated in this study. Among the 20 antimicrobial drugs studied, the resistance rates of K. pneumoniae strains varied from 1.4% (ertapenem) to 23.1% (nitrofurantoin). The antibiotic resistance rates varied significantly among the isolate samples sources for all, with the highest rates for all antibiotics except for nitrofurantoin found in urine samples. In addition, the ESBL-positive rate in urine samples was 27.1%, significantly higher than that of cervical secretions (20.2%), blood (16.5%) and sputum (15.2%). Compared to the ESBL-negative strains, higher resistance rates were detected in the ESBL-positive strains. The most common genotype of isolates from urine was SHV (28%, 23/82), following by TEM (14.6%, 12/82). CONCLUSION The highest resistance rates of K. pneumoniae strains to most antibiotics found in urine samples are partly due to the ESBLs, indicating that a special attention should be paid in the treatment of urinary tract infection.

中文翻译：

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初级卫生保健中心对肺炎克雷伯菌的耐药性进行了为期7年的监测。

背景技术肺炎克雷伯氏菌感染的流行率和耐药率是当前引起关注的原因。但是，缺乏来自基层医院的肺炎克雷伯菌菌株耐药率数据以及不同分离样本来源之间的耐药性分布数据。方法从2011年1月至2017年12月在浙江省中部一家初级卫生保健中心就诊的患者中分离出所有肺炎克雷伯菌菌株。标本包括血液，痰液，宫颈分泌物和尿液。通过Vitek 2紧凑型细菌鉴定和监测系统或VITEK-MS鉴定了该菌种，并使用AST-GN13革兰氏阴性药敏卡（VITEK-2）鉴定了广谱β-内酰胺酶（ESBL）和耐药性。通过检测TEM和SHV基因分析了尿液来源菌株的基因型。最后，使用带有SPSS软件的卡方检验分析了来自不同样品来源的分离株之间的耐药率。结果本研究共分离出5319株肺炎克雷伯菌。在研究的20种抗菌药物中，肺炎克雷伯菌的耐药率从1.4％（厄他培南）到23.1％（硝基呋喃妥因）不等。在所有分离出的样本来源中，抗生素耐药率差异很大，除尿液样本中的呋喃妥因外，所有抗生素的耐药率最高。此外，尿液样本中的ESBL阳性率为27.1％，显着高于宫颈分泌物（20.2％），血液（16.5％）和痰（15.2％）。与ESBL阴性菌株相比，在ESBL阳性菌株中检测到较高的耐药率。尿液分离株最常见的基因型是SHV（28％，23/82），其次是TEM（14.6％，12/82）。结论肺炎克雷伯菌菌株对尿液样本中大多数抗生素的最高耐药率部分归因于ESBLs，这表明在治疗尿路感染时应特别注意。