肠杆菌科细菌耐药性及其耐碳青霉烯类菌株分布特点

Antimicrobial resistance of Enterobacteriacea and distribution characteristics of carbapenemase-resistant strains

目的了解2015年度西京医院肠杆菌科细菌耐药性,以及耐碳青霉烯类肠杆菌科细菌的分布特点,为临床合理应用抗菌药物提供依据。方法对2015年1—12月西京医院住院及门诊患者临床感染标本进行病原菌培养、分离和鉴定,采用K-B纸片扩散法进行药敏试验,采用改良Hodge方法进行碳青霉烯酶确证试验,统计肠杆菌科细菌耐药情况。结果 2015年共检出病原菌4 166株,肠杆菌科细菌1 554株,分离率为37.30%,其中大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、奇异变形杆菌及产气肠杆菌位列肠杆菌科细菌的前5位。787株大肠埃希菌中产ESBLs菌株581株,产酶率为73.82%;367株肺炎克雷伯菌中产ESBLs菌株182株,产酶率为49.59%。大肠埃希菌、肺炎克雷伯菌对头孢唑林耐药率最高,分别为93.14%、78.48%。共检出耐碳青霉烯类抗生素肠杆菌科细菌81株,分离率为5.21%,其中肺炎克雷伯菌41株,阴沟肠杆菌27株,大肠埃希菌13株;主要来自神经外科(42株),消化内科(9株),神经内科(8株)。1.02%(8/787)的大肠埃希菌、3.27%(12/367)的肺炎克雷伯菌具有多重耐药性。结论医院感染病原菌中肠杆菌科细菌所占比例较高,肠杆菌科细菌产ESBLs菌株的检出率较高,耐碳青霉烯类抗生素肠杆菌科细菌分离率较去年有所上升,尤以肺炎克雷伯菌显著。

ObjectiveTo understand antimicrobial resistance of Enterobacteriaceae strains and distribution characteristics of carbapenemaseresistant Enterobacteriaceae（CRE） in Xijing Hospital in 2015, so as to provide basis for rational use of antimicrobial agents in clinic. MethodsSpecimens from infected inpatients and outpatients in Xijing Hospital in JanuaryDecember 2015 were performed pathogenic culture, isolation and identification. Antimicrobial susceptibility testing was performed with KirbyBauer method, carbapenemase confirmatory test was conducted with modified Hodge test, antimicrobial resistance of Enterobacteriaceae was statistically analyzed. ResultsA total of 4 166 pathogenic strains were isolated in 2015, 1 554 （37.30%） of which were Enterobacteriaceae strains, the top 5 isolated pathogens were Escherichia coli（E. coli）, Klebsiella pneumoniae（K. pneumoniae）, Enterobacter cloacae （E. cloacae）, Proteus mirabilis, and Enterobacter aerogenes. Of 787 E. coli strains, 581（73.82%） were extendedspectrum βlactamases（ESBLs）producing strains;of 367 K. pneumoniae strains, 182（49.59%） were ESBLsproducing strains. E. coli and K. pneumoniae had the highest resistance rates to cefazolin, which were 93.14% and 78.48% respectively. A total of 81 （5.21%） CRE were detected, K. pneumoniae, E. cloacae, and E. coli were 41, 27, and 13 strains respectively; strains were mainly isolated from patients in departments of neurosurgery（n=42）, gastroenterology（n=9）, and neurology（n=8） . 1.02%（8/787） of E. coli and 3.27% （12/367） of K. pneumoniae were multidrugresistant. ConclusionEnterobacteriaceae accounted for a higher proportion of pathogenic bacteria causing HAI, the detection rate of ESBLsproducing strains remains high, the isolation rate of carbapenemresistant Enterobacteriaceae is higher than that of last year, especially K. pneumoniae.