2016年~2020年我院耐碳青霉烯类肠杆菌科细菌的分布特点及耐药性分析

Distribution Characteristics and Drug Resistance Analysis of Carbapenem-resistant Enterobacteriaceae in Our Hospital from 2016 to 2020

目的分析本院耐碳青霉烯类肠杆菌科细菌(CRE)感染分布特点及耐药性。方法选取2016年3月~2020年3月本院住院患者分离出的肠杆菌科细菌3591株,采用VITEK 2 Compact全自动微生物分析系统进行细菌鉴定和药敏试验,对筛选出的CRE菌株采用E-test法或K-B药敏纸片法进行药敏试验的复核;分析CRE菌株的标本来源、人群分布、科室、病原菌分布特点及耐药性情况。结果共501例CRE菌株感染患者,其中男性354例;不同性别患者的CRE感染率比较,差异无统计学意义(P>0.05),老年患者的CRE感染率高于非老年患者,差异有统计学意义(P<0.05);CRE菌株标本来源主要以呼吸道标本为主;病原菌主要以肺炎克雷伯菌为主;ICU科室的CRE感染率高于非ICU科室,内科高于外科,差异均有统计学意义(P<0.05);CRE菌株对阿米卡星、妥布霉素和米诺环素的耐药率相对较低,对氨苄西林、氨苄西林/舒巴坦、头孢曲松、头孢呋辛的耐药率>80%;奇异变形杆菌的耐药率较低,对氨曲南、头孢他啶、哌拉西林/他唑巴坦、替卡西林/克拉维酸、头孢哌酮/舒巴坦耐药率均在10%以下。结论CRE菌株对临床多种抗菌药物呈高度耐药,根据其临床分布特点,应加强对ICU和呼吸道相关内科老年患者的关注,指导临床合理应用抗菌药物,采取积极有效措施来降低CRE的感染率。

Objective To analyze the distribution characteristics and drug resistance of carbapenem-resistant Enterobacteriaceae(CRE)infections in our hospital.Methods 3591 strains of Enterobacteriaceae isolated from inpatients in our hospital from March 2016 to March 2020 were selected.Use the VITEK 2 Compact automatic microbial analysis system for bacterial identification and drug susceptibility testing,and use the E-test method or K-B drug susceptibility paper method to review the drug susceptibility test for the selected CRE strains;Analyze the source of specimens,population distribution,departments,pathogen distribution characteristics and drug resistance of CRE strains.Results A total of 501 patients with CRE strain infection,of which 354 were male.There was no significant difference in the CRE infection rate of patients of different genders(P>0.05).The CRE infection rate of elderly patients was higher than that of non-elderly patients,the difference was statistically significant(P<0.05);The source of CRE strain specimens is mainly respiratory specimens;the pathogenic bacteria are mainly Klebsiella pneumoniae;the CRE infection rate in ICU departments is higher than that in non-ICU departments,and internal medicine is higher than surgery,the differences are statistically significant(P<0.05);CRE strains have relatively low resistance rates to amikacin,tobramycin and minocycline,and resistance rates to ampicillin,ampicillin/sulbactam,ceftriaxone,and cefuroxime>80%;The drug resistance rate of Proteus mirabilis is low,and the drug resistance rate to aztreonam,ceftazidime,piperacillin/tazobactam,ticarcillin/clavulanic acid,and cefoperazone/sulbactam are all below 10%.Conclusion CRE strains are highly resistant to a variety of clinical antibacterial drugs.According to their clinical distribution characteristics,attention should be paid to elderly patients in ICU and respiratory related internal medicine,guide the clinical rational use of antibacterial drugs,and take active and effective measures to reduce the infection rate of CRE.