2013—2018年某院不同ICU耐碳青霉烯肠杆菌的变迁

Changes of carbapenem resistant Enterobacteriaceae in different ICUs of a hospital from 2013 to 2018

目的了解我院2013—2018年不同重症监护病房(ICU)耐碳青霉烯肠杆菌(CRE)流行变迁情况及耐药特征,为重点科室CRE防控及治疗提供理论依据。方法采用Phoenix-100、VITEK 2 Compact全自动细菌鉴定/药敏系统,联合纸片扩散法(K-B法)检测耐药性,WHONET 5.6及SPSS 22.0软件统计分析数据。结果 2013—2018年我院各ICU共检出CRE菌株1366株,以肺炎克雷伯菌(85.5%)为主,且逐年增多。心脏外科重症监护(CICU)及新生儿重症监护病房(NICU)CRE检出率小于10%。而中心重症监护病房(ICU)、神经重症监护病房(NSICU)及呼吸重症监护病房(RICU)的CRE检出率分别高达41.07%、48.37%及52.54%,且呈逐年升高趋势。CRE标本来源中以下呼吸道标本(58.93%)为主,其次为血液来源,占14.42%。下呼吸道来源及血液来源的CRE菌株在不同ICU中的构成比均存在差异(P<0.0001)。NSICU及冠心病重症监护病房(CCU)下呼吸道CRE比例最高,分别为78.53%及75.81%。血液来源的CRE构成比最高的病区为儿童重症监护病房(PICU),占22.45%。CRE尚未出现替加环素耐药,对多黏菌素罕见耐药。对阿米卡星、复方磺胺甲噁唑耐药率分别为68.81%和57.43%,对其他药物耐药率均大于85%。结论 CRE总体检出率呈升高趋势,其暴发式增长集中在2014—2015年,并以耐碳青霉烯肺炎克雷伯菌(CRKP)增长为主。不同ICU的CRE检出率差异高达5倍且下呼吸道及血液来源CRE构成比存在差异。不同ICU应针对性的采取感染预防措施进行防控。

Objective To understand the changes of distribution characteristics and drug resistance characteristics of carbapenem resistant Enterobacteriaceae(CRE) in different intensive care units of our hospital during 2013—2018, providing theoretical basis for the prevention and treatment of CRE in key departments. Methods The drug sensitivity test was carried out with the methods of disc diffusion(KB), Phoenix-100 or VITEK 2 Compact automatic bacterial identification/drug sensitivity system. The data were analyzed with WHONET 5.6 and SPSS 22.0 statistical software. Results From 2013 to 2018, a total of 1,366 CRE strains were detected in different ICUs of our hospital, mainly Klebsiella pneumoniae(85.5%), which increased year by year. The detection rates of CRE in CICU and NICU were less than 10%. Meanwhile, the CRE detection rates in ICU, NSICU and RICU were up to 41.07%, 48.37% and 52.54%, respectively, which showed an increasing trend year by year. The lower respiratory tract specimen(58.93%) were the main sources of CRE, followed by blood(14.42%). There were statistical differences in composition ratio of CRE strains from lower respiratory tract and blood in different ICUs(P<0.0001). The proportion of CRE in the lower respiratory tract was highest in NSICU and CCU(78.53% and 75.81%, respectively). The ward with the highest proportion of CRE from blood was the PICU, accounting for 22.45%. Tigacycline resistance was not found in CRE, and polymyxomycin resistance was rare. The drug resistance rates to amikacin and compound sulfamethoxazole were 68.81% and 57.43% respectively, and the resistance rates to other drugs were more than 85%. Conclusion The overall detection rates of CRE showed an increasing trend, and the explosive growth was concentrated in 2014—2015, which was dominated by the growth of carbapene-resistant Klebsiella pneumoniae(CRKP). The detection rate of CRE in different ICUs was up to five times different, and the composition ratio of CRE in the lower respiratory tract and blood source was different. Specific measures should be taken to prevent and control infections in different ICUs.