耐碳青霉烯类肠杆菌科细菌临床分布及耐药性研究

Clinical distribution and drug resistance of Enterobacteriaceae resistant to carbapenem

目的观察耐碳青霉烯类药物的CRE(肠杆菌科细菌)分布情况,分析其耐药性,为临床合理用药治疗提供指导,以确保患者用药安全。方法于2020年3月—2021年3月收集新乡市第二人民医院各科室送检标本,分离CRE,使用微生物系统鉴定菌株,并开展药物敏感性试验,利用K-B纸片扩散法复核耐药结果,通过改良优化的Hodge试验明确CRE产酶情况,分析并统计其结果。结果总共收集100株CRE,其中85株肺炎克雷伯菌、11株阴沟肠杆菌、4株大肠埃希菌;主要分布于重症监护病房,占比70.00%,然后是肿瘤科,占比14.00%;CRE菌株之中,51.00%株源自于痰标本、25.00%株源自于尿标本。药物敏感性试验结果发现除了阿米卡星,CRE对其他种类的抗菌药物具有90%以上的耐药性。结论CRE耐药性较高,广泛分布于重症监护病房;这就需要临床引起高度重视,合理应用碳青霉烯类抗菌药物,积极防控医院感染,以免感染流行、暴发。

Objective To observe the distribution of carbapenem resistant CRE(Enterobacteriaceae)and analyze its drug resistance,so as to provide guidance for clinical rational drug use,To ensure the safety of medication for patients.Methods From March 2020 to March 2021,the samples were collected from our hospital,CRE was isolated,the strains were identified by microbial system,and drug sensitivity test was carried out.K-B disk diffusion method was used to review the drug resistance results.The enzyme production of CRE was determined by improved Hodge test,and the results were analyzed and counted.Results A total of 100 strains of CRE were collected,including 85 strains of Klebsiella pneumoniae,11 strains of Enterobacter cloacae and 4 strains of Escherichia coli;It was mainly distributed in intensive care unit(70.00%),followed by oncology department(14.00%);Among the CRE strains,51.00%were from sputum samples and 25.00%from urine samples.In addition to amikacin,CRE had more than 90%resistance to other antibiotics.Conclusion CRE is highly resistant and widely distributed in ICU;This requires clinical attention,rational use of carbapenems antibiotics,active prevention and control of hospital infection,so as to avoid infection epidemic.