2016—2018年耐碳青霉烯菌检出情况回顾分析

Retrospective analysis of carbapenem-resistant bacteria detection from 2016 to 2018

目的了解我院近三年耐碳青霉烯菌的分离情况和药物敏感性测试结果,分析近期耐碳青霉烯菌感染和耐药变迁趋势。方法回顾我院2016-2018年临床分离的耐碳青霉烯菌的标本来源、分离结果和耐药情况。采用Whonet 5.6和SPSS 22.0软件处理分析数据。结果调研2016-2018年临床标本共检出耐碳青霉烯菌1 093株,检出率为7.4%,检出数量呈逐年上升趋势。检出耐碳青霉烯菌中铜绿假单胞菌442株(40.4%)、鲍曼不动杆菌374株(34.2%)、肺炎克雷伯菌140株(12.8%)、大肠杆菌39株(3.6%)、脑膜败血伊丽莎白金菌27株(2.5%)、产吲哚金黄杆菌20株(1.8%)以及其它细菌51株(4.7%)。阳性标本来源最多为痰,占总检出率58.3%。药物敏感性测试结果显示耐碳青霉烯菌肠杆菌对阿米卡星、庆大霉素和多西环素具有较高敏感性,分别为63.6%、33.3%和25.9%;耐碳青霉烯非发酵革兰氏阴性杆菌对左氧氟沙星、阿米卡星、利福平敏具有较高敏感性,分别为38.0%、35.8%、25.4%。除此之外,耐碳青霉烯菌对其它抗生素均表现出高度耐药性。结论近期耐碳青霉烯菌检出数量呈上升趋势,并显示出广泛的抗生素耐药性。因此,建议加强其分布和耐药性监测,以指导合理使用抗生素。

Objective Through investigating the isolation and drug sensitivity test results of carbapenem-resistant bacteria (CRB) in our hospital in the recent past three years to understand the variations of tendency of drug-resistance and infection status caused by CRB. Methods By retrospecting the specimen source of clinically separated CRB, separation results and drug resistance in our hospital from 2016 to 2018, the data were analyzed by Whonet 5.6 and SPSS 22.0 software. Results A total of 1 093 CRB strains were isolated from 2016 to 2018, which accounts for a positive rate of 7.4% and the number of CRB strains detected was increased gradually. These CRB strains included pseudomonas aeruginosa (442 strains,40.4%), Acinetobacter baumannii (374 strains,34.2%), Klebsiella pneumoniae (140 strains,12.8%), Escherichia coli (39 strains,3.6%), Elizabethkingia meningosepticum (27 strains,2.5%), Chryseobacterium indologenes (20 strains,1.8%) and other bacteria (51 strains, 4.7%). The main sources of specimen of CRB was sputum, which contributing 58.3% of the CRB strains. Drug sensitivity test results showed that carbapenem-resistant enterobacteria (CRE) were highly sensitive to amikacin, gentamicin and doxycyclin, with antibiotic sensitive rates of 63.6%, 33.3% and 25.9%respectively;while carbapenem resistantnon-fermented gram-negative bacilli were highly sensitive to levofloxacin, amikacin and rifampicin, with antibiotic-sensitive rates of 38.0%, 35.8% and 25.4% respectively. Conclusion The number of CRB isolation is increased gradually in recent years, and shows multiple-drug resistance. Therefore, the distribution and drug resistance monitoring should be strengthened in order to guide the rational use of antibiotics.