嘉兴地区耐碳青霉烯类肠杆菌科细菌感染特点和耐药性分析

Characteristics and antibiotic resistance of carbapenem-resistant Enterobacteriaceae in Jiaxing area

目的调查嘉兴地区耐碳青霉烯类肠杆菌科细菌(CRE)的分布及耐药性,为临床提供合理的诊治与预防控制,为院感监测提供流行病学资料。方法收集本地区五家综合性医院2013年1月—2014年2月期间59株CRE的临床资料,对其细菌分布、标本来源、科室分布、细菌耐药性进行统计分析;细菌鉴定及药敏采用VITEK-2Compact细菌鉴定系统,并采用K-B法复核碳青霉烯类药敏结果。改良Hodge试验(MHT)检测碳青霉烯酶表型,IP/IPI复合纸条检测金属酶表型。结果检测到的CRE以肺炎克雷伯菌为主,占44.1%,其次为阴沟肠杆菌,产气肠杆菌等;感染标本以尿液为主,占52.5%,痰为第2位,占39.0%;临床科室以ICU为主,其次为神经外科、呼吸内科等;药敏结果示,对阿米卡星、复方新诺明、庆大霉素的耐药率为42.4%、47.5%、55.9%,对其他抗菌药物的耐药率均较高。MHT试验59株中45株阳性,占76.3%;其中金属酶13株阳性,占28.9%(13/45)。结论本地区CRE选择抗菌药物的范围较窄,做好多药耐药菌的控制,对防止耐药菌株的流行具有重要意义。

Objective To investigate distribution and drug resistance of carbapenem-resistant Enterobacteriaceae,epidemiological data was collected for monitoring nosocomial infection. Methods Fifty-nine CRE were isolated from five general hospitals from Jan 2013 to Feb 2014,the bacterial distribution,specimen source,division distribution and the bacterial drug resistance were statistically analyzed. VITEK-2 Compact system was used to identify and test sensitivity to antibiotics of CRE. Kirly-Baner（ KB） method was used to test the antimicrobial susceptibility. The modified Hodge test was used to detect the carbapenemase. Composite IP / IPI was used to detect metal enzyme phenotypes. Results Of all the CRE strains detected,Klebsiella pneumoniae was dominated,accounting for 44. 1%,followed by Enterobacter cloacae,Enterobacter aerogenes etc;CRE were mostly from urine,accounting for 52. 5%,the second was sputum,accounting for 39. 0%;most of the patients were from ICU,then was neurosurgery,respiratory medicine,etc;the drug susceptibility testing showed that the drug resistance rates to amikacin,trimethoprim-sulfamethoxazole,gentamicin were 42. 4%,47. 5% and 55. 9%,respectively,and the drug resistance rate to other antibiotics was relatively high. Of 59 strains CRE,45 strains（76. 3%）were positive for MHT,and among these,13 strains 28. 9%（13 /45） were positive for metal enzyme. Conclusion The selection of antibiotics was limited for CRE. Reasonable use of antibiotics on the basis of drug susceptibility testing and control the multidrug-resistant bacteria had great significance in preventing the prevalence of drug resistance strains.