耐碳青霉烯类抗菌药物肠杆菌科细菌耐药特性的分析

Analysis of drug resistance to carbapenem-resistant Enterobacteriaceae

目的探讨耐碳青霉烯类抗菌药物肠杆菌科细菌的临床分布及耐药特性,以便更好地指导临床控制和治疗此类细菌的感染。方法常规方法进行菌株分离,经革兰染色、氧化酶试验等初筛,再经VITEK-32型全自动微生物分析仪进行菌株鉴定,K-B法进行药物敏感试验。结果 2011年1月至2012年6月共检测到56株耐碳青霉烯类药物的肠杆菌科细菌,主要有肺炎克雷伯菌33株(58.9%)、阴沟肠杆菌10株(17.9%)、产酸克雷伯菌和大肠埃希菌各5株(8.9%)。以下呼吸道标本痰液为主,占55.4%(31/56),其次为伤口分泌物12.5%(7/56)。病区分布前4位的分别是ICU(30.4%)、神经外科(17.9%)、呼吸内科(12.5%)和肾内科(10.7%)。56株实验菌中有8株泛耐药,泛耐药率达14.3%,耐碳青霉烯类药物肠杆菌科细菌对常用16种抗菌药物耐药率>60%的有15种,其中耐药率>90%的也有6种,分别为氨苄西林、氧哌秦青霉素、头孢呋辛、头孢他啶、头孢吡肟、亚胺培南。耐药率最低的为阿米卡星(42.9%)。结论耐碳青霉烯类药物的肠杆菌科细菌的多重耐药性严重,甚至泛耐药,临床无经验抗菌药物可选,必须依据药敏试验的结果选用敏感的抗菌药物进行治疗。

To explore clinical distribution and drug resistance of carbapenem-resistant Enterobacteriaceae and to provide better guidance to clinical control and therapy. Methods At first, the strains was isolated by Gram stain and oxidase test, and finally identified by VITEK-32 automatic bacteria identification system. The drug sensitivity tests were performed by Kirby-Bauer method. Results A total of 56 carbapenem-resistant Enterobacteriaceae were isolated from Jan 2011 to June 2012, including 33 strains ofKlebsiella pneumoniae （58.9%）, 10 strains of Enterobacter cloacae （17.9%）, 5 strains of Klebsiella oxytoca （8.9%） and 5 strains of Escherichia coli （8.9%）. The specimens were mainly come from lower respiratory tract （55.4%） and secondly come from wound secretions （12.5%）. The top four units were ICU （30.4%）, neurosurgery unit （17.9%）, respiratory medical unit （12.5%） and nephrology unit （10.7%）. In the 56 strains, 8 of them were pan drug-resistant （14.3%）, and all of them were 〉60% resistant to the fifteen drugs which belong to the common-sixteen-drugs. Moreover, the resistant rates of ampicillin, piperacillin, cefuroxime, ceftazidime, cefepime and imipenem, were more than 90%. Amikacin have got the lowest resistant rate （42.9%）. Conclusion Drug resistance of carbapenem-resistant Enterobacteriaceae was very serious. There was no empirical antibiotic for clinical therapy. It is necessary to select sensitive antibiotics for clinical therapy according to the drug sensitive test results.