成人肠杆菌科菌血症病原菌的临床分布及耐药性分析

Clinical distribution and drug resistance analysis of adult patients with Enterobacteriaceae bacteremia

目的了解医院内成人肠杆菌科菌血症病原菌的临床分布及耐药现状,为临床合理使用抗菌药物提供依据。方法收集成人菌血症患者血培养标本进行病原学鉴定,分析成人肠杆菌科菌血症病原菌的临床分布及其对常见抗菌药物的敏感度,比较产超广谱β-内酰胺酶(ESBLs)阳性与阴性的肠杆菌科病原菌对常见抗菌药物的耐药率。结果共分离出成人肠杆菌科菌血症病原菌354株,主要来源于血液科、感染科、急诊科、肝胆外科,主要菌种为大肠埃希菌、克雷伯杆菌、阴沟肠杆菌。其中,对大肠埃希菌耐药率较低的抗菌药物有亚胺培南、美罗培南、厄他培南、哌拉西林/克拉维酸钾、替卡西林钠/克拉维酸钾、阿莫西林/克拉维酸钾、头孢西丁钠,耐药率均低于15%;耐药率较高的抗菌药物有氨苄西林、哌拉西林、头孢呋辛、头孢唑林钠、头孢曲松钠、头孢噻肟钠,耐药率均不低于50%。ESBLs阳性108株,检出率为31%。ESBLs阳性肠杆菌株对常见抗菌药物的耐药率普遍高于ESBLs阴性肠杆菌株(P均<0.05),但两者对亚胺培南、美罗培南、厄他培南、哌拉西林/克拉维酸钾、替卡西林钠/克拉维酸钾的耐药率相近(P均>0.05)。共检出耐碳青霉烯类肠杆菌科菌血症病原菌13株,其中大肠埃希菌、肺炎克雷伯杆菌各5株,产气肠杆菌2株,阴沟肠杆菌1株。检出多耐药菌株221株,检出率为62%。结论成人肠杆菌科菌血症病原菌耐药现象普遍存在,应关注耐碳青霉烯类抗菌药物及多耐药现象,并加强耐药性监测,从而指导临床合理用药。

Objective To investigate the clinical distribution and drug resistance of hospitalized adult patients with Enterobacteriaceae bacteremia, aiming to provide evidence for rational use of antibiotics in clinical practice. Methods The blood samples were collected from adult patients with Enterobacteriaceae bacteremia for pathogenic identification. The clinical distribution and drug sensitivity of the pathogens to common antibiotics were analyzed. The drug resistance rate of pathogenic enterobacteriaceae producing positive and negative extended spectrum β-lactamase(ESBLs) was statistically compared. Results A total of 354 enterobacteriaceae strains were isolated from Department of Hematology, Department of Infectious Diseases, Emergency Department and Department of Hepatobiliary Surgery. The strains mainly included Escherichia coli, Klebsiella. Escherichia coli and Enterobacter cloacae. Escherichia coli possessed a low drug resistance rate(< 15%) to imipenem, meropenem, ertapenem, piperacillin/clavulanate potassium, ticarcillin/clavulanate potassium, amoxicillin/clavulanate potassium and cefoxitin. Escherichia coli yielded a high drug resistance rate (≥ 50%) to ampicillin, piperacillin, cefuroxime, cefazolin, ceftriaxone and cefotaxime. ESBLS-positive strains were detected in 108 cases with a detection rate of 31%. The drug resistance rate of ESBLs-positive strains to common antibiotics was significantly higher compared with that of ESBLs-positive strains(all P<0.05), whereas the drug resistance rates to imipenem, meropenem, ertapenem, piperacillin/clavulanate potassium and ticarcillin/clavulanate potassium did not significantly differ(all P>0.05). A total of 13 carbapenemresistant Enterobacteriaceae strains were detected, including 5 strains of Escherichia coli, 5 strains of Klebsiella pneumoniae, 2 strains of Enterobacter aerogenes and 1 strain of Enterobacter cloacae. In total, 221 multi-drug resistant strains were identified with a detection rate of 62%. Conclusions Drug resistance is prevalent in adult patients with Enterobacteriaceae bacteremia. Extensive attention should be paid to carbapenem-resistant drugs and multi-drug resistance. The monitoring of drug resistance should be strengthened to provide guidance for rational drug use in clinical settings.