耐碳青霉烯类肠杆菌科细菌临床分布及耐药性研究

Research on the clinical distribution and drug resistance of carbapenem-resistant Enterobacteriaceae

目的：了解临床分离的耐碳青霉烯类肠杆菌科细菌（CRE）的菌株分布和耐药性，为合理使用抗生素提供依据。方法：采用VITEK2compact对本院2016年1月N2017年8月肠杆菌科细菌进行鉴定和药敏试验，部分药敏试验采用纸片扩散法进行测试。结果：7092株肠杆菌科细菌中，检出CREl89株，占2．7％，以肺炎克雷伯菌（84株，44．4％）为主。CRE菌株主要来源于重症监护室，标本主要来源于痰液、尿液、血液。药敏结果显示：CRE对临床上常用的β-内酰胺类抗生素高度耐药，对氨基糖苷类抗生素较敏感（耐药率≤33．3％）；喹诺酮类抗生素对肺炎克雷伯菌和阴沟肠杆菌敏感性较好，对大肠埃希茵耐药率≥70．0％。结论：ICU患者是CRE院内感染易感人群，同时CRE对常用抗生素耐药率高。因此，医院应做好院感监测，临床合理使用抗生素。

Objective： To investigate the clinical distribution and drug resistance of carbapenem-resistant Enterobacteriaceae （C1KE） strains separated in the hospital, Methods： Enterobacteriaceae strains from January 2016 to August 2017 were identified by VITEK2 Compact, and antibiotic susceptibility tests were determined by Kirby-Bauer （K-B） method and automatic systems. Results： 189 strains of CRE isolated from 7092 Enterobacteriaceae were screened. K. pneumonia （84 strains,44.4%） was the main kind of carbopenems-resistant strains. CtKE strains mainly came from intensive care unit （ICU） . The strains were mainly isolated from respiratory tract samples, urine and blood. The CRE strains remained highly resistant to β-1actam antibiotics, yet they were sensitive to aminoglycoside antibiotics （resistant rate≤33.3%）. ICpneumonia and E.cloacae tended to be sensitive to quinolones. However, the resistant rate of E.coli to quinolones was more than 70.0%. Oorlolusion： ICU patients are susceptible population ofnosocomial CtKE infection and these strains were inclined to be resistant to normal antibiotics.It is necessary to take effective measures to prevent and control the hospital acquired infections. Clinicians should use antibiotics rationally.