儿童患者检出耐碳青霉烯类抗菌药物肠杆菌科细菌分布特征及耐药性分析

Distribution and drug resistance of carbapenem-resistant Enterobacteriaceae in Children

目的了解儿童患者临床分离的耐碳青霉烯类抗菌药物肠杆菌科细菌(carbapenem resistant Enterobacteriaceae,CRE)的分布特征及耐药性,为临床合理用药提供实验室依据。方法收集2016年1月至2018年12月儿科送检标本分离出的革兰阴性菌,采用VITEK 2 Compact全自动微生物鉴定系统及纸片扩散法进行药敏试验。结果本研究分离出284株CRE,耐碳青霉烯类肺炎克雷伯菌(carbapenem resistant Klebsiella pneumoniae,CR-KPN)232株(81.7%),居第一位;其次为耐碳青霉烯类阴沟肠杆菌(carbapenem resistant Enterobacter cloacae,CR-ECL)23株(8.1%)、耐碳青霉烯类大肠埃希菌(carbapenem resistant Escherichia coli,CR-ECO)17株(6.0%)。CRE主要来自ICU病房(包括NICU、PICU、SICU),总计217株(76.1%)。痰标本检出CRE居第一位(209株,73.3%),其次为气管导管(31株,10.9%)。CR-KPN检出患者的年龄以新生儿(<28d)及婴儿(≥28d^1岁)为主,分别为57.4%及48.8%。亚胺培南MIC值分布≥16μg/mL的CR-KPN约为81.0%,CR-ECL约为21.7%,CR-ECO约为70.6%。CR-KPN对阿米卡星、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星、复方磺胺甲噁唑敏感性高,敏感率均大于90%,氨曲南次之,敏感率为43.5%。CR-ECL对阿米卡星敏感率为95.7%,对环丙沙星、左氧氟沙星均无耐药株。CR-ECO对阿米卡星敏感性高,敏感率为94.1%,庆大霉素、妥布霉素次之,敏感率分别为64.7%、58.8%。结论我院检出的CRE以肺炎克雷伯菌为主,检出科室以ICU病房为主,标本来源主要为下呼吸道标本。新生儿及婴儿CR-KPN的检出较其它年龄段更高。CR-KPN、CR-ECO亚胺培南MIC值分布≥16μg/mL比例高,对常见抗菌药物耐药形式严峻,应引起高度重视。

Objective To investigate the distribution and drug-resistance of carbapenem-resistant Enterobacteriaceae(CRE) from children in pediatrics in our hospital and provide the basis of the rational use of antibiotics. Methods From January 2016 to December 2018, the isolates of CRE from pediatrics were collected, the VITEK-2 system and the disk diffusion method were used to conduct drug sensitivity tests. Results A total of 284 clinical CRE were collected, including 232(81.7%) strains of K. pneumoniae, 23(8.1%) strains of E. cloacae and 17(6.0%) strains of E. coli. Totally 217(76.1%) strains of CRE strains were isolated from the department of intensive care unit(ICU), including neonatal intensive care unit(NICU), pediatric intensive care unit(PICU), and surgery intensive care unit(SICU). Totally 209(73.3%) strains of CRE were is olated from sputum specimens and 31(10.9%) strains of CRE were isolated from tracheal aspirate specimens. The patients detected with CR-KPN were mainly neonates(<28 d) and infants(≥28 d^1 y), which were 57.4% and 48.8%, respectively. The MICs of imipenem against CR-KPN(81.0%), CR-ECL(21.7%) and CR-ECO(70.6%) were no less than 16μg/mL. The sensitivity rate of CRE-KPN against amikacin, gentamycin, tobramycin, ciprofloxacin, levofloxacin, and trimethoprim/sulfamethoxazole were no less than 90%. About 43.5% of CRE-KPN isolates were still susceptible to aztreonam. No CR-ECL strains were found resistant to ciprofloxacin and levofloxacin. About 94.1% of isolates were susceptible to amikacin in CR-ECO strains. The drug susceptibility rate of the CR-ECO strains to gentamycin and tobramycin were 64.7% and 58.8%. Conclusion The main isolate of CRE in pediatrics in our hospital was K. pneumoniae. Most of CRE strains were isolated from ICU. The specimens were mainly from lower respiratory tract specimens. The detection rates of CR-KPN were higher in newborns and infants than in other age groups. Most of the MICs against imipenem in CRE-KPN strains and CRE-ECO strains were higher than 16μg/mL.