2015—2019年上海某中西医结合医院住院患者碳青霉烯类耐药肠杆菌科细菌耐药性分析

Incidenceand resistance profile of carbapenem-resistant Enterobacteriaceae among inpatients in a clinical center in Shanghai from 2015 to 2019

目的分析上海中医药大学附属岳阳中西医结合医院住院患者碳青霉烯类耐药肠杆菌科细菌(CRE)分离趋势及耐药谱。方法收集2015—2019年分离自住院患者各类临床标本的肠杆菌科细菌5980株,采用VITEK 2 Compact 60全自动微生物鉴定仪鉴定细菌种类,采用纸片扩散法或自动化仪器法进行体外药物敏感性试验。结果2015—2019年共检出CRE 923株(15.4%),且CRE检出率呈上升趋势。CRE感染患者年龄为(76.9±14.5)岁,≥60岁的老年患者占89.8%;60.5%的CRE分离自呼吸道标本(558株);全院30个临床科室均有检出,其中老年科检出率最高(21.5%),其次是重症监护病房(20.9%);全院CRE以肺炎克雷伯菌为主(77.7%),其次是大肠埃希菌(10.9%)。体外药物敏感性试验结果显示,CRE对大多数常用抗菌药物的耐药率>80.0%,对替加环素、多黏菌素B、阿米卡星、复方磺胺甲噁唑、妥布霉素、庆大霉素的耐药率相对较低,分别为4.1%、5.9%、51.7%、58.4%、66.5%和75.0%。结论2015—2019年上海中医药大学附属岳阳中西医结合医院住院患者CRE检出率整体呈上升趋势,主要易感人群为≥60岁老年患者,CRE涉及科室范围广泛,且对多数临床常用抗菌药物高度耐药,医院应加强CRE感染防控,合理使用抗菌药物。

Objective To analyze the incidence and resistantspectrum of carbapenem-resistant Enterobacteriaceae(CRE)in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine form 2015 to 2019.Methods A total of 5980 strains of Enterobacteriaceae were collected from various clinical specimens of inpatients from 2015 to 2019.VITEK 2 Compact 60 automatic bacterial identification system was used to identify the bacteria.Antimicrobial susceptibility testing was carried out using Kirby-Bauer method or automated system.Results A total of 923 strains(15.4%)of CRE were isolated,and the incidence of CRE showed a significant upward trend.The mean age of patients with CRE infection was(76.9±14.5)years old,and patients aged≥60 years old accounted for 89.8%.CRE was isolated mainly from respiratory tract specimens(558 strains,60.5%),and distributed in 30 clinical departments.In these departments,the geriatrics department had the highest detection rate(21.5%),followed by 20.9%in the intensive care unit.Among 923 CRE isolates,carbapenem-resistant Klebsiella pneumonia was the most prevalence species(77.7%),followed by carbapenem-resistant Escherichia coli(10.9%).Drug sensitivity test results showed that the resistance rates of CRE to the commonly used antibiotics were above 80.0%,and the resistance rates to tigecycline,polymyxin B,amikacin,trimethoprim/sulfamethoxazole,tobramycin and gentamicin were relatively low(4.1%,5.9%,51.7%,58.4%,66.5%and 75.0%)Conclusion The CRE incidence rate of inpatients in Yueyang Hospital is on the rise from 2015 to 2019.CRE were mainlyisolatedfrom elderly patientsaged≥60 years old.CRE strains involve a wide range of clinical departmentand show high resistance to most commonly used antimicrobials.Hospitals should strengthen the prevention and control of CRE infection and intelligent use of antibiotics.