碳青霉烯耐药肠杆菌科细菌感染的临床流行病学研究

Clinical Epidemiological Study on Carbapenem-resistant Enterobacteriaceae Bacterial Infection

目的分析碳青霉烯耐药肠杆菌科细菌感染的临床分布及耐药特点,为控制感染、延缓和减少细菌耐药性的发生提供理论指导。方法收集山东省菏泽市立医院2016年1月—2017年12月临床分离的碳青霉烯耐药肠杆菌科细菌菌株,按照美国临床实验室标准协会(CLSI2016)推荐方法进行抗菌药物敏感性实验,统计分析相关数据。结果2016年1月—2017年12月该院共检出碳青霉烯耐药肠杆菌科细菌220株,占同期分离该院肠杆菌科细菌的比例为13.1%(220/1 678),在重症监护病房内碳青霉烯耐药肠杆菌科细菌的检出率为最高53.4%(114/220)。分离标本中以痰液标本(63.2%)为主要来源,其次是脓液标本(11.8%)和尿液标本(10.0%)。碳青霉烯耐药肠杆菌科细菌对甲氧苄啶/磺胺甲恶唑的耐药率最低,为32.2%,对其它临床常用抗菌药物耐药程度严重,耐药率多>70.0%。结论碳青霉烯耐药肠杆菌科细菌临床分离株数较多,临床分离率高,对多数临床常用抗菌药物耐药程度严重,部分具有泛耐药的特点,医院须对碳青霉烯耐药肠杆菌科细菌加强监控工作,尤其是ICU内的菌株,应引起足够重视。

Objective To analyze the clinical distribution and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae bacterial infections and provide theoretical guidance for controlling infection, delaying and reducing the occurrence of bacterial resistance. Methods The clinical isolates of carbapenem-resistant Enterobacteriaceae strains were collected from Heze City Hospital of Shandong Province from January 2016 to December 2017. The antimicrobial susceptibility tests were performed according to the recommendations of the American Institute of Clinical Laboratory Standards（CLSI2016）. Statistical analysis was performed. Results A total of 220 carbapenem-resistant enterobacteriaceae bacteria were detected in the hospital from January 2016 to December 2017, accounting for the same period of time. The proportion of bacteria was 13.1%（220/1 678）, and the detection rate of carbapenem-resistant Enterobacteriaceae in the intensive care unit was 53.4%（114/220）, and sputum specimens were isolated from the isolated specimens（63.2%） was the main source,followed by pus specimens（11.8%） and urine specimens（10.0%）. Carbapenem-resistant Enterobacteriaceae had the lowest resistance to trimethoprim/sulfamethoxazole of 32.2%, the degree of resistance to other commonly used antibiotics was severe, and the resistance rate was more than 70.0%. Conclusion Carbapenem-resistant Enterobacteriaceae have a large number of clinical isolates and high clinical isolation rate. The degree of drug resistance is severe, some of them have the characteristics of pan-drug resistance, and the hospital must Ene-resistant Enterobacteriaceae strengthen the monitoring work, especially strains in the ICU, attention should be paid.