某三级综合医院耐碳青霉烯肠杆菌科细菌流行特征及耐药性分析

Epidemiological characteristics and drug resistance analysis of carbapenem resistant Enterobacteriaceae in a tertiary general hospital

目的研究2016-2018年内蒙古某三级综合医院耐碳青霉烯肠杆菌科细菌流行特征及耐药性变化,旨在为临床治疗提供科学依据。方法选择内蒙古自治区人民医院2016年1月1日-2018年12月31日医院感染患者作为研究对象,通过收集住院患者耐碳青霉烯类肠杆菌科细菌(Carbapenem-resistant Enterobacteriaceae,CRE)菌株,对其流行特征及耐药情况进行分析。结果三年间共检出病原菌5138株,其中CRE 176株,检出率为3.43%,且有升高的趋势(P<0.05)。176株CRE中主要分离的细菌为肺炎克雷伯菌125株占71.02%、大肠埃希菌25株占14.20%。CRE菌株分离来源前三位痰液为61.93%,尿液为11.93%和血液为10.23%。临床各科室分离的CRE菌株,主要分布在ICU、干部保健病房和神经外科。CRE患者男性检出率(69.89%)高于女性(30.11%)(P<0.001);各年龄组CRE检出情况中60岁年龄组检出率最高为36.93%,随着患者年龄的增长,检出率有增高的趋势((P<0.001)。医院三年间耐碳青霉烯肠杆菌科细菌对各类抗菌药物均表现出不同程度的耐药,其中对亚胺培南三年均100.00%耐药,对青霉素类和头孢菌素类耐药率均在80%左右,对头孢他啶、头孢曲松耐药率三年呈上升趋势,分别由2016年的73.53%和76.47%上升到2018年的100.00%和98.41%;对替加环素、多黏菌素和庆大霉素较敏感。结论该医院3年间CRE检出率呈上升趋势,根据送检结果和患者的病情,应严格执行抗菌药物的分级管理,实施个体化抗菌药物治疗方案,控制CRE在医院发生和传播。

OBJECTIVE To study the epidemiological characteristics and drug resistance changes of carbapenem-resistant Enterobacteriaceae in a tertiary general hospital in Inner Mongolia People′s Hospital from 2016 to 2018,so as to provide a scientific basis for clinical treatment.METHODS Patients admitted in the Inner Mongolia Autonomous Region People′s hospital from Jan.1,2016,to Dec.31,2018 were selected as the research subjects.The epidemiological characteristics and drug resistance of carbapenem-resistant Enterobacteriaceae(CRE)strains were analyzed by collecting them from hospitalized patients.RESULTS A total of 5,138 strains of the pathogenic bacteria were detected in three years,including 176 strains of CRE,with a detection rate of 3.43%and an increasing trend(P<0.05).Among the 176 strains of CRE,125 strains of Klebsiella pneumoniae accounted for 71.02%,and 25 strains of Escherichia coli accounted for 14.20%.The top three sources of CRE strains were 61.93%in sputum,11.93%in urine and 10.23%in blood.The CRE strains isolated from various clinical departments were mainly distributed in ICU,cadre health ward and neurosurgery.The detection rate of male CRE patients(69.89%)was significently higher than that of females(30.11%)(P<0.001);Among all age groups,the highest detection rate of CRE in the 60-year-old age group was 36.93%,with a tendency for the detection rate to increase with the age(P<0.001).The carbapenem-resistant Enterobacteriaceae bacteria in the hospital showed varying degrees of resistance to various antimicrobial drugs during the three years,among them,the resistance rate to imipramine in three years were 100.00%,the resistance rate to penicillins and cephalosporins were 80%,and the resistance to cefotaxime and ceftriaxone showed an upward trend in three years,rising from 73.53%%and 76.47%%in 2016 to 100.00%and 98.41%,respectively,in 2018;they were sensitive to tigecycline,polymyxin and gentamicin.CONCLUSION The detection rate of CRE in this hospital showed an increasing trend during 3 years.Therefore,relevant departments and divisions should strictly implement the hierachical management of antimicrobial drugs,and implement individualized antimicrobial treatment plans based on the results of inspection and patients′conditions to control the occurrence and spread of CRE in the hospital.