耐碳青霉烯类肠杆菌科细菌的分布及耐药性分析

Strains Distribution and Drug Resistance Analysis of Carbapenem-resistant Enterobacteriaceae

目的：分析耐碳青霉烯类肠杆菌科细菌的分布情况及耐药性。方法：收集丽水市中心医院2010年12月～2013年6月临床分离的耐药菌株,采用法国梅里埃Vitek-2 compact细菌鉴定仪鉴定细菌,药物敏感性试验采用纸片扩散法（K-B法）。结果：共收集耐药菌株83株,其中肺炎克雷伯菌占68.67%,产气肠杆菌和阴沟肠杆菌各6.02%,大肠埃希菌2.41%。标本来源最常见为痰液（80.72%）,其次尿液（8.43%）和分泌物（4.82%）,科室分布最多者为重症监护病房（39.76%）,其次为神经外科（36.51%）。74例患者在检测出耐药菌株前1个月内使用过至少一种抗菌药。有69.88%和31.33%的患者使用过哌拉西林/他唑巴坦和头孢哌酮/舒巴坦,15.66%和10.84%使用过亚胺培南/西司他丁和美罗培南。耐药菌株对多黏菌素B高度敏感,对米诺环素和阿米卡星的耐药率为13.25%和28.92%,对其他抗菌药的耐药率多介于70%～100%。结论：耐碳青霉烯类肠杆菌科细菌在医院重症监护病房和神经外科相对集中,对多数临床常用抗菌药呈高度耐药,给临床治疗带来严重的挑战。医院应做好院感监测,合理使用抗菌药,从而有效预防和控制耐药菌株的产生和传播。

Objective： To study the distribution and susceptibility of carbapenem-resistant Enterobacteriaceae （CRE） isolates in Lishui central hospital. Methods： Strains of CRE were collected from December 2010 to June 20!3 in Lishui central hospital. Strains were detected by Vitek-2 compact and the antimicrobial susceptibility testing were carried out using Kirby-Bauer method. Results： Eighty-three strains of CR.E were collected, of which Klebsiella p～umonia, Enter- obacter cloacae, Enterobacter aerogenes and Escherichia coli accounted for 68.67% ,6.02% ,6.02% and 2.41%. The iso- lated rate from sputum, urine and secretion were 80.72% ,8.43% and 4.82%. The distribution rates of CRE in Intensive Care Unit （ICU） and neurosurgery department were 39.76% and 36.51%. 74 patients used at least one kind of antimicro- bial in a month before CRE was detected, 69.88% of patients have used piperacillin/tazobactam, while cefoperazone/sul- bactam was 31.33%. 15.66% and 10.84% of patients have used imipenem/cilastatin and meropenem. All isolates were sensitive to polymyxin B. The resistance rate of CRE isolates to most of antimicrobial agents was 70% -100% except mino- cycline（ 13.25% ） and amikacin（28.92% ）. Conclusion： The CRE isolates were mainly isolated from specimen of sputum in ICU and neurosurgery department. It takes serious challenge to the clinical treatment because the antibiotic resistance of CRE isolates is much higher. So according to susceptibility test, the hospital should enhance the drug-resistance surveillance and use antibiotics reasonable to control the multi-drug resistance and the prevalence of resistant strains.