陕西某三甲医院558株耐碳青霉烯类肠杆菌临床分布及耐药性

Analysis of clinical distribution and drug resistance of 558 carbapenem-resistant Enterobacteria in a tertiary hospital in Shaanxi Province

目的分析院内耐碳青霉烯肠杆菌(CRE)的流行特征、分布特点及耐药性,为大型综合医院感染防控及临床治疗提供依据和参考。方法调取陕西某三甲医院2018年1月-2020年12月就诊患者中确诊为CRE感染的病例,收集患者及CRE菌株信息,回顾性分析感染情况和临床特征。结果三年共检出肠杆菌6698株,其中CRE 558株,分离率为8.3%。从年龄分布来看,中年人检出CRE最多。检出CRE最多的科室为ICU,占48.0%,其次为门急诊12.9%和烧伤科12.0%。CRE菌株标本来源排名前五位的分别为痰液、尿液、分泌物、引流液和血液。病原菌主要为肺炎克雷伯菌,其次为阴沟肠杆菌和大肠埃希菌。其中,肺炎克雷伯菌对β-内酰胺类、氟喹诺酮类药物耐药率几乎均>90%。氨苄西林、哌拉西林、头孢呋辛、头孢曲松、头孢唑林和头孢噻肟等对各种CRE均表现出100%耐药。碳青霉烯类中厄他培南对各种CRE耐药率均>96%,总体耐药率最高,而美罗培南相对较低,但也均>50%。多黏菌素B和替加环素均较敏感。结论大型综合医院CRE检出率较高,多药耐药现象严重。应严格管控碳青霉烯类药物的使用强度,制定医院感控策略,防止进一步传播。

OBJECTIVE To analyze the epidemic characteristics,distribution characteristics and drug resistance of selected as the research objects.By collecting information on patients and CRE strains,the clinical characteristics were retrospectively analyzed.METHODS The patients diagnosed with CRE infection from Jan 2018 to Dec 2020 in a tertiary hospital in Shaanxi were collected,information on patients and CRE strains were collected,and the infection status and clinical characteristics were retrospectively analyzed.RESULTS A total of 6698 strains of Enterobacteriaceae were isolated in the past three years,including 558 strains of CRE,with an isolation rate of 8.3%.From the perspective of age distribution,the majority of CRE was isolated in middle age group.The CRE strains were collected from various clinical departments,of which mainly distributed in ICU,accounting for 268 strains(48.0%),followed by outpatient and emergency department(12.9%)and burning department(12.0%).The top five sources of CRE specimens were sputum,urine,secretion,drainage fluid and blood,respectively.The main pathogens were Klebsiella pneumoniae,followed by Enterobacter cloacae and Escherichia coli.Among these bacteria,the resistance rates of K.pneumoniae toβ-lactam and fluoroquinolone antibiotics were almost all above 90%.Ampicillin,piperacillin,cefuroxime,ceftriaxone,cefazolin and cefotaxime showed 100%resistance to various CRE.Among carbapenems,ertapenem showed the highest overall resistance rate(>96%),while meropenem was relatively low,but also more than 50%.CRE strains showed sensitive polymyxin B and tigecycline.CONCLUSION CRE isolation rate is high in large general hospitals,and multi-drug resistance is serious.The use intensity of carbapenems should be strictly controlled,and formulate in-hospital infection control strategies to prevent further spread.