碳青霉烯耐药肠杆菌科细菌临床分布及耐药特征分析

Clinical distribution and antimicrobial resistance of carbapenem-resistant Enterobacteriaceae

目的分析综合性三甲医院住院患者临床标本分离碳青霉烯耐药肠杆菌科细菌(CRE)的临床分布及耐药特征,为临床抗感染治疗及院感防控提供参考。方法收集2015年7月至2017年6月安徽医科大学第二附属医院住院患者临床标本分离CRE药敏数据及相关临床资料,应用WHONET 5.6软件统计分析CRE临床分布及耐药率,药敏折点参照CLSI 2016版标准。结果2015年7月至2017年6月期间,自住院患者临床标本共分离CRE 82株,由肺炎克雷伯菌(42株,51.22%)、大肠埃希菌(23株,28.05%)、阴沟肠杆菌(9株,10.98%)、黏质沙雷菌(5株,6.10%)、弗劳地枸橼酸杆菌(2株,2.44%)及产酸克雷伯菌(1株,1.22%)构成。临床标本以痰标本(29株,35.37%),分泌物/脓液标本(20株,24.39%)及尿液标本(14株,17.07%)为主。CRE分布广泛,检出的临床科室包括ICU(14株,17.07%)、呼吸内科(10株,12.20%)等。CRE菌株对临床常用抗菌药物耐药性较高,仅对阿米卡星较为敏感,耐药率为23.17%。结论 CRE菌株临床分布广泛且对常用抗菌药物耐药率高,临床科室应积极送检病原学检验并根据药敏结果合理选择抗菌药物。医院感控部门应联合微生物实验加强对CRE菌株的监测与防控。

Objective To analyze the antimicrobial resistant characteristics and clinical distribution of carbapenem-resistant Enterobacteriaceae(CRE)isolated from clinical specimens in a tertiary hospital in Anhui province so as to provide reference data for nosocomial infection control and clinical antibiotic therapy.Methods Clinical information and antimicrobial susceptibility data of CRE isolated from clinical specimens between July 2015 and June 2017 were collected.Distribution characteristics and antimicrobial resistance rate of CRE isolates were analyzed by WHONET5.6,according to CLSI 2016 guideline.Results FromJuly 2015 to June 2017,a total of 82 strains of CRE were isolated from clinical specimens,including Klebsiella pneumoniae(n=42,51.22%),Escherichia coli(n=23,28.05%),Enterobacter cloacae(n=9,10.98%),Serratia marcescens(n=5,6.10%),Citrobacter freundii(n=2,2.44%),and Klebsiella oxytoca(strain 1.22%).The main clinical specimens were sputum specimens(n=29,35.37%),secretion/pus specimens(n=20,24.39%),and urine specimens(n=14,17.07%).They hadwidedistribution in clinical departments,and the main departmens.were ICU(n=14,17.07%),Respiratory Medicine Dept.(n=10,12.20%)and so on.CRE strains showed a high level resistance to routine antibiotics,but only sensitivity to amikacin,andthe resistant rate was 23.17%.Conclusion CRE strain is widely distributed and has a high resistance rate to common antibiotics.Bacterial culture should be carried out actively,and the antibiotics should be rationally selected according to the susceptibility result.Both office of nosocomial Infection control and microbiology laboratory should strengthen the monitoring of CRE.