临床分离碳青霉烯类耐药肠杆菌科分布及其酶的表型分析

Distribution of clinically isolated carbapenem-resistant Enterobacteriaceae and phenotypic analysis of their enzyme

目的了解医院碳青霉烯类耐药肠杆菌科(CRE)临床分布及其酶的表型。方法采用回顾性调查方法,对某医院临床分离CRE菌株分布及其碳青霉烯类药物的耐药表型进行分析和评估。结果从住院患者送检标本中共分离到CRE 98株,其中肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌分居前3位,构成比依次为72.45%、10.20%和7.14%。m CIM试验阳性的CRE菌株90株,其中产金属β-内酰胺酶菌株26株,产丝氨酸碳青霉烯酶菌株64株。肺炎克雷伯菌中,以产丝氨酸酶表型为主(95.38%),大肠埃希菌和阴沟肠杆菌均以产金属β-内酰胺酶为主,分别占88.89%和100.00%。结论该医院临床分离CRE(头孢他啶-阿维巴坦)菌株主要为肺炎克雷伯菌;碳青霉烯酶表型以丝氨酸碳青霉烯酶为主;不同菌种的酶类型差异明显。

Objective To investigate the clinical distribution of carbapenem-resistant Enterobacteriaceae(CRE)and the phenotype of its enzymes in hospital.Methods A retrospective investigation method was used to analyze and evaluate the distribution of clinically isolated CRE strains in a hospital and their carbapenem-resistant phenotypes.Results A total of98 CRE strains were isolated from the submitted specimens of hospitalized patients.Among them,Klebsiella pneumoniae,Escherichia coli and Enterobacter cloacae were the top 3 CRE strains,and their constituent ratios were 72.45%,10.20%and 7.14%,respectively.90 CRE strains were positive for m CIM test,of which 26 strains were metal-β-lactamase-producing strains and 64 strains were serine carbapenemase-producing strains.Among Klebsiella pneumoniae,the serine carbapenase-producing strains were dominated,while both Escherichia coli and Enterobacter cloacae were mainly the metal-β-lactamase-producing phenotype,accounting for 88.89%and 100.00%,respectively.Conclusion The clinically isolated CRE(ceftazidime-avibactam)strains in this hospital are mainly Klebsiella pneumonia;the carbapenemase phenotype is mainly serine carbapenemase;the enzyme types of different strains are significantly different.