耐碳青霉烯类肠杆菌科细菌的临床分布特征及耐药性分析

CLINICAL DISTRIBUTION CHARACTERISTICS AND DRUG RESISTANCE ANALYSIS OF CARBOPENEM RESISTANT ENTEROBACTERIACEAE

目的:分析碳青霉烯类耐药的肠杆菌科细菌(CRE)的临床分布特征及其耐药率,是为指导临床医师合理使用抗菌药物提供参考依据。方法:收集2016-01~2019-03期间我院各临床科室送检标本中,分离到的碳青霉烯类耐药的肠杆菌科细菌(CRE),使用VITEK 2 Compact微生物分析系统,对收集到的菌株进行鉴定及药敏试验,采用纸片扩散法(K-B)对亚胺培南耐药结果进行复核,用改良Hodge试验对CRE的产酶情况进行确认,并对结果进行统计分析。结果:共收集碳青霉烯类耐药的肠杆菌科细菌(CRE)236株,其中,主要菌株是肺炎克雷伯菌(201株)、阴沟肠杆菌(17株)和大肠埃希菌(15株);49.2%的CRE菌株来源于呼吸道感染痰液标本,24.6%来源于泌尿系感染中段尿标本;58.1%的标本分布在各科重症监护病房,其次是干部保健病房和肿瘤科,分别占13.6%和12.7%。药敏结果显示CER除了对阿米卡星的耐药率相对较低(83.02%),对其他抗菌药物则表现为非常高的耐药率,均在94.10%以上。结论:碳青霉烯类耐药的肠杆菌科细菌(CRE)表现为高耐药性,临床分布有明显特征,以重症监护病房为主。强调抗菌药物的合理使用非常重要,同时也要加强医院院内感染的预防和控制,避免院内交叉感染及暴发流行。

Objective:To analyze the clinical distribution characteristics and drug resistance rate of carbopenem resistant enterobacteriaceae(CRE),so as to provide reference for clinical doctors to use antimicrobial agents reasonably.Methods:The strains of carbopenem resistant enterobacteriaceae were collected from January 2016 to March 2019 from various clinical departments.The identification and drug sensitivity test of those strains were tested by VITEK 2 Compact microbial analysis system.Kirby-Bauer(k-b)was used to review the results of imipenem resistance,and improved Hodge test was used to confirm the enzyme production of CRE,and the results were statistically analyzed.Results:A total of 236 strains of carbopenem resistant enterobacteriaceae(CRE)were collected,among which the main strains were klebsiella pneumoniae(201 strains),enterobacter cloacae(17 strains)and escherichia coli(15 strains).49.2%of the CRE strains were from sputum specimens of respiratory tract infection,and 24.6%were from urine specimens of urinary tract infection.58.1%of the samples were distributed in intensive care units,followed by cadre care units and oncology units,accounting for 13.6%and 12.7%,respectively.The drug sensitivity results showed that the drug resistance rate of CER to amikacin was relatively low(83.02%),while that to other antibiotics was very high(above 94.10%).Conclusion:Carbopenem resistant enterobacteriaceae(CRE)show high drug resistance and are distributed in intensive care units.It is emphasized that the rational use of antimicrobial agents is very important,and the prevention and control of nosocomial infection should also be strengthened to avoid cross infection and outbreak.