长沙某医院分离226株CRE临床特征及耐药分析

Clinical characteristics and drug resistance analysis of 226carbapenem-resistant Enterobacterales strains isolated from a hospital in Changsha

目的:回顾性分析长沙某医院分离226株碳青霉烯类耐药肠杆菌科细菌(carbapenem-resistant Enterobacterales,CRE)的临床分布特征、耐药情况及表型,为临床治疗和院感控制提供依据。方法:收集2019年10月~2020年9月该院分离的非重复226株CRE,进行菌种结构、标本来源、科室构成等临床特征分析;并通过碳青霉烯酶抑制剂增强试验分析其产碳青霉烯酶类型;WHONET5.6软件统计分析结果。结果:在分离得到226株CRE中,以肺炎克雷伯菌(95.6%)为主,其次是大肠埃希菌(3.5%)、弗劳地柠檬酸杆菌(0.9%)等;标本分布以下呼吸道标本(67.3%)为主,其次为尿液(15.0%)、分泌物(伤口、脓液)(5.3%)等;科室分布以重症医学科(29.2%)为主,其次为呼吸内科(18.6%)、急症ICU(12.4%)、神经内外科(11.5%)、中医科(11.1%)等。CRE几乎对临床常用抗生素全部耐药,仅对替加环素、黏菌素、米诺环素保持较低耐药率,其中CRE以产丝氨酸碳青霉烯酶为主。结论:CRE对多种抗菌药物高度耐药,且主要以产丝氨酸碳青霉烯酶为主,给临床治疗中带来巨大挑战。因此急需临床合理使用抗菌药物,加强对该菌监测,严控院内感染。

Objective To retrospectively analyze the clinical distribution,drug resistance and phenotype of carbapenem-resistant Enterobacterales(CRE)isolated from a hospital in Changsha,so as to provide basis for clinical treatment and nosocomial infection control.Methods The clinical characteristics such as strain structure,sample source and department composition of non-repetitive CRE,isolated from October 2019 to September 2020 were analyzed.Carbapenem inhibitor enhancement test was carried out to analyze the types of carbapenemases,and WHONET5.6 software was used to analyze the results.Results Among the 226 strains of CRE,Klebsiella pneumoniae(95.6%)was dominant,followed by Escherichia coli(3.5%),Citrobacter freundii(0.9%),etc.The lower respiratory tract samples were mainly distributed(67.3%),followed by urine(15.0%),secretions(wound,pus)(5.3%),etc.The departments were mainly distributed in the department of critical medicine(29.2%),followed by the department of respiratory medicine(18.6%),emergency ICU(12.4%),neurosurgery(11.5%),traditional Chinese medicine(11.1%)and so on.CRE was resistant to almost all antibiotics commonly used in clinic,but only to tegacycline,colistin and minocycline,among which CRE mainly produced serine carbapenem.Conclusion CRE is highly resistant to many antibiotics and mainly produces serine carbapenem,which brings brings great challenge to clinical treatment.Therefore,antibiotics should be used rationally in clinic,the surveillance of the bacteria should be strengthened,and the spread of nosocomial infection should be strictly controlled.