某地区耐碳青霉烯类抗菌药物肠杆菌科细菌的临床感染状况及耐药性分析

Analysis of infection status and drug resistance to clinically isolated carbapenem-resistant Enterobacteriaceae

目的分析某地区耐碳青霉烯类抗菌药物肠杆菌科细菌(CRE)的检出率、临床感染状况及耐药性,为临床合理治疗提供依据。方法回顾性分析2010年-2016年从临床分离筛选出的177株CRE的临床特点与耐药性,采用Walk Away96全自动微生物分析仪对菌株进行鉴定和药敏试验,采用WHONET 5.6软件对菌株分布及药敏结果进行统计分析。结果 2010年-2016年共分离到肠杆菌科细菌7 580株,其中CRE177株占2.3%。CRE菌株主要来源于痰标本占62.1%,患者所在科室主要为ICU和脑外科,分别占45.8%和22.0%,CRE中种类最多的是肺炎克雷伯菌,占79.1%。CRE对21种抗菌药物的耐药性,除复方新诺明和四环素的耐药率较低,分别为15.3%和28.2%外,对多种抗菌药物保持较高的耐药性,均>75.0%。结论 CRE的检出逐年增加,耐药情况严重,临床应采取措施防止该类菌株的暴发性传播。

Objective To analyze the detection rate and clinical distribution characteristics and drug resistance of carbapenem-resistant Enterobacteriaceae（CRE）,so as to provide basis for clinical treatment. Methods 177 strains of CRE were screened from clinical isolates from 2010 to 2016,and its clinical characteristics and resistance were conducted for retrospective analysis.Identification and drug sensitivity tests were carried out using Walk Away96 full automatic microbial analyzer. The strain distribution and drug sensitivity were statistically analyzed by WHONET5. 6 software. Results From 2010 to 2016,a total of 7 580 strains of Enterobacteriaceae were isolated,and 177 strains of CRE accounted for 2. 3%. CRE specimens were from sputum samples,accounting for 62. 1%,and patients mainly came from ICU and Neurosurgery,respectively accounting for 45. 8% and22. 0%,most of the CRE was Klebsiella pneumoniae,accounting for 79. 1%. The drug resistant rates of these CRE were higher than 75. 0% in most of 21 kinds of antibiotics,while that to sulfamethoxazole and tetracycline were respectively 15. 3% and28. 2%. The resistance of CRE to 21 antimicrobial agents was higher,except that to compound sulfamethoxazole and tetracycline（15. 3%,28. 2%）,and the resistance of CRE to many antibiotics was high,with the average resistance rate more than75. 0%. Conclusion The detection of CRE is increasing year by year and drug resistance is serious. Measures should be taken to prevent the outbreak of the strain.