2013-2018年耐碳青霉烯类肠杆菌科细菌的分布特点及耐药性分析

Distribution characteristics and drug resistance analysis of carbapenem-resistant Enterobacteriaceae bacteria during 2013-2018

目的了解临床分离的耐碳青霉烯类肠杆菌科细菌(CRE)的分布特点及其耐药特征,为临床合理用药提供依据。方法回顾性分析该院2013年1月至2018年12月临床标本分离的CRE,对CRE的科室分布、标本来源及药敏试验结果进行系统性分析。结果6年共收集临床分离的CRE 663株,CRE检出率为4.29%,总体呈现逐年上升趋势。663株CRE中以肺炎克雷伯菌(75.72%)为主,其次是大肠埃希菌(8.14%)、阴沟肠杆菌(6.64%)、黏质沙雷菌(3.77%)与产酸克雷伯菌(3.02%)。肺炎克雷伯菌检出率自2013年的3.71%快速上升至2018年的18.10%,呈现明显上升趋势(P<0.01);黏质沙雷菌自2017年起检出率明显上升,其他细菌6年间检出率上升趋势不明显。标本来源主要为痰液标本(53.85%),科室分布主要来自重症监护室(35.75%)。药敏试验结果显示,CRE除对复方磺胺甲噁唑和四环素的耐药率稍低(耐药率分别为46.46%和52.03%),对其他抗菌药物耐药率均>70.00%。不同菌种对抗菌药物的耐药性不同。结论6年间CRE大体上呈现逐年上升趋势,且对临床常用抗菌药物具有较高耐药性,临床医生应严格按照药敏试验结果合理使用抗菌药物,同时医院需要加强对感染的预防和控制,做好CRE的检测与管理,避免医院内感染的暴发、流行。

Objective To understand the clinical distribution and drug resistance characteristics of clinically isolated carbapenem-resistant Enterobacteriaceae(CRE)bacteria to provide a basis for reasonable medication use in clinic.Methods The clinically isolated CRE bacteria in this hospital from January 2013 to December 2018 were retrospectively analyzed,and the systematic analysis included the specimen source,department distribution and drug susceptibility test results.Results A total of clinically isolated 663 CRE strains were collected,and the detection rate of CRE was 4.29%showing a overall increasing trend year by year.Among 663 strains,Klebsiella pneumoniae(75.72%)was predominant,followed by Escherichia coli(8.14%),Enterobacter cloacae(6.64%),Serratia marcescens(3.77%)and Klebsiella oxytosca(3.02%).The detection rate of Klebsiella pneumoniae was increased from 3.71%in 2013 to 18.10%in 2018,showing an obvious increasing trend(P<0.01);the detection rate of Serratia marcescens was increased significantly since 2017,whereas the increasing trend of other bacterial detection rate within 6 years was unobvious.The specimen source was mainly the sputum sample(53.85%)and the department distribution mainly came from ICU(35.75%).The drug susceptibility results showed that except the resistance rates of CRE to cotrimoxazole and tetracycline was slightly lower(46.46%and 52.03%respectively),the resistance rates of CRE to other commonly used antibacterial drugs was greater than 70.00%.Different bacterial species had different resistance to antibacterial drugs.Conclusion CRE shows the increasing trend year by year during these 6 years generally,and has highly resistant to most of the commonly used antibacterial drugs.Clinicians should rationally use antibacterial drugs in strict accordance with the results of drug susceptibility tests,meanwhile the hospital needs to strengthen the prevention and control of infection,and do well the detection and management of CRE in order to avoid the outbreak and epidemics of nosocomial infection.