老年尿路感染患者中碳青霉烯耐药肠杆菌科细菌的临床特征及分子流行研究

Characteristics and molecular epidemiology of carbapenem resistant Enterobacteriaceae in elderly patients with urinary tract infection

目的探讨医院老年尿路感染患者中碳青霉烯耐药肠杆菌科细菌(CRE)的临床特征与分子流行情况。方法收集某三甲医院2014年1月-2018年12月尿路感染的老年患者第1次送检的清洁中段尿标本,共分离出肠杆菌科细菌2412株,采用VITEK MS全自动快速微生物质谱检测系统及VITEK 2Compact全自动微生物鉴定仪及相关配套试剂对病原菌分别进行鉴定及药敏试验。结果2412株肠杆菌科细菌中共分离出CRE 63株,占2.6%,主要以肺炎克雷伯菌(kpn,25株)、大肠埃希菌(eco,20株)、阴沟肠杆菌(ecl,9株)等为主,主要分布在老年医学科(32例)、重症监护室(12例)、泌尿外科(8例)等科室。分析kpn与eco的药敏情况,两者对抗菌药物均具有较高的耐药率,且kpn对哌拉西林/他唑巴坦、亚胺培南、呋喃妥因等抗菌药物的耐药性要分别高于eco(P<0.05);而对于其它抗菌药物,两者间的耐药性无明显差异(P>0.05)。对比老年尿路感染患者中CRE与非CRE对抗菌药物的耐药率,两者除对复方新诺明的耐药性无明显差异(P>0.05)外,CRE对其余所检测抗菌药物的耐药性均显著高于非CRE(P<0.05)。分析CRE中主要病原菌的耐药机制,肺炎克雷伯菌主要以产KPC-2型碳青霉烯酶为主,大肠埃希菌主要以产NDM-5、NDM-1型碳青霉烯酶为主。结论老年患者尿路CRE感染发生率高且其对抗菌药物的耐药性亦维持较高水平,在治疗中应遵循规则选用药物,对CRE做到预防为主,对分离到CRE的患者要及时隔离,做好院感相关监测及防护工作,建立起对多重耐药菌及抗菌药物应用频次与强度的监管制度,减少由于防控不当、抗菌药物的滥用所致的多重耐药菌的产生与播散。

Objective To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant Enterobacteriaceae(CRE)in elderly patients with urinary tract infection.Methods 2412Enterobacteriaceae bacteria isolated from the urine specimens of urinary tract infection in elderly patients were collected in a hospital from January 2014to December 2018.Pathogens were identified by VITEK MS and drug sensitive were tested by VITEK 2Compact.Results Of 2412pathogenic strains,63(2.6%)were CRE,mainly Klebsiella pneumoniae(n=25),Escherichia coli(n=20),Enterobacter cloacae(n=9)and mainly distributed in the department of geriatrics(n=32),intensive care unit(n=12),clinical urology(n=8).Klebsiella pneumoniae and Escherichia coli have higher resistance to antimicrobial agents.The drug resistance of Klebsiella pneumoniae to piperacillin/tazobartan,imipenem,furantoin had upward trend than Escherichia coli(P<0.05).However,there were no significant differences for other antimicrobial agents(P>0.05).Besides,the cumulative drug resistance of CRE to all antimicrobial agents were significantly different than that of non-CRE(P<0.05),except for sulfamethoxazole/trimethoprim(P>0.05).Genetic analysis of drug resistance of main pathogenic bacteria showed that Klebsiella pneumoniae was mainly KPC-2,while Escherichia coli was mainly NDM-5and NDM-1.Conclusion The incidence and resistance rate of CRE isolated from the elderly patients by urinary tract infection was higher level.Clinicians should select antimicrobial agents according to the medicinal indication so as to control effectively and avoid timely the spread of CRE.