2010—2016年耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分布及其耐药特征

Distribution and antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli in 2010-2016

目的了解临床分离的耐碳青霉烯类肺炎克雷伯菌(CRKP)及耐碳青霉烯类大肠埃希菌(CREC)的临床分布状况及耐药特征。方法回顾性分析某院2010年1月—2016年12月临床标本分离的肺炎克雷伯菌及大肠埃希菌,统计分析CRKP及CREC分离情况。结果 2010—2016年7年共收集临床分离耐碳青霉烯类肠杆菌科细菌(CRE)310株(CRKP268株,CREC42株),CRKP检出率由2010年的1.33%上升到2016年的12.70%,呈逐年上升趋势(χ2=123.73,P<0.01);CREC检出率则处于相对稳定状态,2010—2016年均约为1.00%;标本来源和病区分布最多者分别为呼吸道标本(45.49%)和重症监护病房(31.93%)。药敏试验结果显示,CRKP和CREC除对阿米卡星耐药率稍低(分别为80.60%、38.10%)外,对大多数临床常用抗菌药物如第三代头孢菌素类、第四代头孢菌素类、β-内酰胺类/酶抑制剂类、喹诺酮类等耐药率CRKP均>90%、CREC均在80%左右,而非CRE菌株的耐药率低于CRE菌株(P<0.01)。结论 7年间临床分离的CRKP的检出率呈现快速增加的趋势,几乎对常用抗菌药物均耐药,应予以高度关注。

Objective To understand the clinical distribution and antimicrobial resistance characteristics of clinically isolated carbapenemresistant Klebsiella pneumoniae （CRKP） and carbapenemresistant Escherichia coli （CREC）. MethodsClinically isolated Klebsiella pneumoniae and Escherichia coli from a hospital between January 2010 and December 2016 were analyzed retrospectively, isolation of CRKP and CREC were conducted statistical analysis. ResultsFrom 2010 to 2016, a total of 310 carbapenemresistant Enterobacteriaceae （CRE） isolates （268 were CRKP strains and 42 were CREC strains） were collected, isolation rate of CRKP increased from 1.33% in 2010 to 12.70% in 2016, showing an increasing trend year by year （χ2=123.73, P〈 0.01）; isolation rate of CREC was relatively stable, were all about 1.00% from 2010 to 2016. Most specimens were respiratory tract specimens （45.49%） and from intensive care unit （31.93%）. Antimicrobial susceptibility testing showed that except resistance rates of CRKP and CREC were slightly lower to amikacin （80.60% and 38.10% respectively）, resistance rates of CRKP to most commonly used antimicrobial agents, such as third generation cephalosporins, fourth generation cephalosporins, βlactamase/lactamase inhibitors, and quinolones were all〉90%, resistance rates of CREC to above antimicrobial agents were all about 80%, resistance rate of nonCRE strains was lower than that of CRE strains （P〈0.01）. ConclusionDuring the past 7 years, detection rate of clinically isolated CRKP increased rapidly, were almost resistant to commonly used antimicrobial agents, which should be paid close attention.