2017年江苏地区碳青霉烯类耐药肠杆菌科细菌的分布特点和耐药性分析

Analysis for distribution and susceptibility of carbapenem-resistant Enterobacteriaceae isolates in Jiangsu province during 2017

目的了解2017年"江苏省细菌耐药监测网"耐碳青霉烯类肠杆菌科细菌(CRE)的分布特点及其耐药性。方法收集2017年1月至12月监测网内10 560株CRE菌株,药物敏感性试验采用纸片扩散法(K-B法)和自动化仪器MIC法,结果判断参照2017年版美国临床和实验室标准化协会(CLSI)M100-S27标准。结果 10 560株CRE菌株中,克雷伯菌属、大肠埃希菌、肠杆菌属分别占57.6%、12.3%、9.8%;标本来源和科室分布最多者为呼吸道标本(占59.4%)和重症监护室(占31.5%);全省CRE的平均检出率为8.4%,其中徐州地区高达16.3%,泰州仅为4.0%。CRE菌株对多种临床常用抗菌药物高度耐药,除阿米卡星的耐药率(42.7%)较低外,对其他抗菌药物的耐药率为56.0%~94.6%;儿童分离菌株对氨曲南、阿米卡星、庆大霉素、环丙沙星、妥布霉素的耐药率均低于成人分离株,差异有统计学意义(P<0.01);但对氨苄西林/舒巴坦、头孢唑林、头孢他啶、头孢西丁、亚胺培南的耐药率却高于成人分离株,差异有统计学意义(P<0.01)。结论 CRE菌株对多数临床常用抗菌药物呈高度耐药,菌株分布呈现地区和院内不同病区的差异性。应对之进行流行病学调查,并采取有效的感染防控措施以遏制其在医院中的播散。

Objective To investigate the distribution characteristics and susceptibility of carbapenem-resistant Enterobacteriaceae （CRE） isolates from Jiangsu Province Antimicrobial Resistant Investigation Net during 2017. Methods A total of 10 560 CRE isolates were collected from January to December 2017. Antimicrobial susceptibility test was carried out according to unified protocol using Kir-by-Bauer method or MIC in automated Systems. The judgment for results was referred to the breakpoints of CLSI 2017 M100-S27. Results Of 10 560 CRE isolates, Klebsiella spp., Escherichia coli and Enterobacter spp. accounted for 57.6%, 12.3% and 9.8%, respectively. Of the 10 560 isolates, the most antibiotic resistant isolates were collected from respiratory tract and ICU （59.4% and 31.5%, respectively）. The average detectable rate of CRE in the whole Jiangsu province was 8.4%. The highest detectable rate was 16.3% in Xuzhou, and the lowest detectable rate was 4.0% in Taizhou. The antibiotic resistance of CRE isolates was so high that the resistant rates of most antibiotics were from 56.0% to 94.6%, except for amikacin which showed low detectable rate （42.7%）. CRE i- solates from adults were more resistant to aztreonam, amikacin, gentamicin, ciprofloxacin and tobramycin than that from children （P〈 0.01）. However, the CRE isolates from children were more resistant to ampicillin/sulbactam, cefazolin, ceftazidime, cefoxitin and imipenem with statistical difference than that from adults（P〈0.01）. Conclusion The CRE isolates were highly resistant to most com- monly used antibacterial drugs in clinical practice. The distribution of the CRE was different in various regions of the whole province and various hospital wards. Therefore, epidemiological investigation and effective measures for infection control should be carried out to prevent the spread of CRE in hospitals.