2015—2017年某儿童医院耐碳青霉烯类肠杆菌科细菌分布及耐药性分析

Analysis of bacterial distribution and drug resistance of carbapenem-resistant Enterobacteriaceae in a children’s hospital from 2015 to 2017

目的分析某三甲儿童医院临床标本分离耐碳青霉烯类肠杆菌科细菌(CRE)的分布及耐药情况,为临床抗感染治疗及医院感染防控提供参考。方法收集2015年1月1日—2017年12月31日期间住院患儿临床标本分离出CRE菌株的药敏数据及相关资料,对数据进行统计分析。结果住院患儿临床标本共分离CRE菌株723株,总检出率15.47%,主要为肺炎克雷伯菌590株、大肠埃希菌77株、阴沟肠杆菌15株。标本类型主要为痰液535株、血液43株、肺泡灌洗液35株。CRE菌株分布广泛,科室来源主要为新生儿重症监护室、早产儿病房、内科监护室。CRE对β-内酰胺类抗菌药物耐药率在90%以上,对氨基糖苷类、喹诺酮类、四环素等抗菌药物耐药率在81%以下。结论CRE菌株的检出率呈现出较高水平,CRE的临床分布广泛且对常用抗菌药物耐药率高,应多部门联动加强对CRE的监测与防控,合理应用抗菌药物。

Objective To analyze the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae (CRE) in clinical specimens in a tertiary children's hospital, and provide reference for clinical anti-infective treatment, prevention, and control of nosocomial infections. Methods The drug susceptibility data and related data of CRE strains were collected from clinical specimens of hospitalized children from January 1, 2015 to December 31, 2017, and the data was statistically analyzed. Results A total of 723 CRE strains were isolated from clinical specimens of hospitalized children. The total detection rate was 15.47%, including 590 strains of Klebsiella pneumoniae, 77 strains of Escherichia coli, and 15 strains of Enterobacter cloacae. The specimen types were mainly 535 sputum, 43 blood sputum, and 35 alveolar lavage fluid. CRE strains were widely distributed, and the main sources of the departments were neonatal intensive care unit, premature infant ward, and pediatric intensive care unit. The resistance rate of CRE to β-lactam antibiotics was more than 90%, and the resistance rate to antibiotics such as aminoglycosides, quinolones and tetracycline was less than 81%. Conclusions The detection rate of CRE strains was high. The clinical distribution of CRE was extensive and the resistance rate to commonly used antibiotics was high. The monitoring and prevention of CRE should be strengthened by Multi-sector linkage, and antibacterial drugs should be used rationally.