2009～2014年重庆地区儿童感染阴沟肠杆菌的临床分布及耐药性分析

Distribution and antimicrobial resistance of Enterobacter cloacae isolates from children in Chongqing from 2009 to 2014

目的 了解重庆地区儿童2009~2014年感染阴沟肠杆菌的临床分布特征及耐药性,为合理应用抗菌药物和预防控制医院感染提供依据。方法 分析2009~2014年检出的阴沟肠杆菌对15种抗菌药物的耐药性,采用BD Phoenix 100全自动微生物鉴定/药敏系统,以最小抑菌浓度（MIC）结合K-B纸片扩散法进行药敏试验,按美国临床实验室标准化协会（CLSI）标准判断结果。结果 共分离阴沟肠杆菌3 384株,检出率为4.18%;以呼吸道标本多见,占83.04%。阴沟肠杆菌对美洛培南和亚胺培南的耐药率最低,分别为0.88%和0.94%;对左氧氟沙星、环丙沙星、哌拉西林/他唑巴坦的耐药率分别为4.38%、5.17%,26.49%。2009～2014年阴沟肠杆菌对15种抗菌药物的耐药率比较,差异均有统计学意义（P〈0.05）。共检出产超广谱β-内酰胺酶（ESBLs）阴沟肠杆菌87株,占2.57%。新生儿病房和呼吸病房检出阴沟肠杆菌的构成比高于其他病区,分别为26.92%、24.32%。结论 阴沟肠杆菌的耐药性呈上升趋势,新生儿科与呼吸科是预防控制的重点科室。

Objective To investigate the distribution and antibiotic resistance of Enterohacter cloacae isolated from children in Chongqing area from 2009 to 2014,in order to provide references for rational use of antibiotics and nosocomial infections prevention and control. Methods Antibiotic resistance in Enterobacter cloacae isolated from 2009 to 2014 to 15 kinds of antibacterial agents was analysed. Identifications and antibiotic susceptibility test（AST） of clinical isolates of Enterobacter cloacae were performed by using BD Phoenix 100 automated system,which were based on the minimal inhibitory concentration（MIC） method and BauerKirby agar disk diffusion susceptibility test. The AST results were interpreted according to the guidelines of the Clinical and Laboratory Standards Institute（CLSI）. Results A total of 3 384 strains of Enterobacter cloacae were isolated, accounting for 4.18%. Most strains of Enterobacter cloacae were isolated from sputum specimens, accounting for 83. 04%. The resistance rate of Enterobacter cloacae against meropenem and imipenem was the lowest,which was 0.88% and 0.94% respectively. The resistance rate of Enterobacter cloacae against levofloxacin, ciprofloxacin and piperacillin/tazobactam was 4.38 %, 5.17 % and 26.49 %, respectively. The resistance rates against 15 different antibiotics in Enterobacter cloacae strains isolated from 2009 to 2014 were statistically significant different（P〈0.05）. A total of 87 isolates（2.57 % ） produced extended-spectrum β-lactamases. The constituent ratio of Enterobacter cloacae in neonatology department and respiratory ward was higher than that in other wards,which was 26.92% and 24.32% ,respectively. Conclusion The resistance rate of Enterobacter cloacae shows an increasing trend. Preventing and control measures should be focus on the neonatology department and resDiratorv ward.