2014—2019年贵州某医院耐碳青霉烯类肠杆菌目细菌的耐药及分布特点

Drug Resistance and Distribution Characteristics of Carbapenem-resistant Enterobacteriaceae Bacteria in a Hospital in Guizhou from 2014 to 2019

目的分析贵州某三甲医院2014—2019年近5年耐碳青霉烯类肠杆菌目细菌(carbapenem-resistant Enterobacteriaceae bacteria,CRE)的分布及耐药性。方法采用自动化仪器MIC法、纸片扩散法(K-B法)和E-Test法结合对临床分离CRE进行药敏试验,并按2019年CLSI标准判断药敏试验结果,采用WHONET 5.6软件做回顾性统计分析。结果2014—2019年共分离1163株CRE,其中耐碳青霉烯类肺炎克雷伯菌(CRKP)667株占57.35%,耐碳青霉烯类大肠埃希菌(CRECO)134株,占11.52%。CRE主要分离自重症监护室(ICU,148株,12.73%)、神经内科重症监护室(NICU,96株,8.25%)和急诊科重症监护室(EICU,87株,7.48%),以呼吸道标本(587株,50.15%)及尿液标本(187株,16.11%)来源为主。药敏结果显示CRE普遍耐药,其中CRKP对大多数抗菌药物耐药率在90.0%以上;CRECO对阿米卡星敏感,耐药率仅为20.1%;耐碳青霉烯类阴沟肠杆菌对喹诺酮类抗菌药物左氧氟沙星、环丙沙星的耐药率为30.6%、41.8%。结论CRE耐药情况严峻,临床应根据药敏结果制定合理的抗感染治疗方案,并加强医院感染控制措施的落实,减少耐药菌的产生。

Objective To investigate the distribution and drug resistance of carbapenems-resistant Enterobacteriaceae bacteria in a third-grade A hospital in Guizhou in recent 5 years from 2014 to 2019.Methods Bacterial susceptibility testing was performed by MIC,KB or E-Test method.Results were analyzed according to CLSI2019.All data were analyzed by WHONET5.6 sofeware.Results A total of 1163 strains of carbapenemresistant Enterobacteriaceae(CRE)were isolated from 2014 to 2019,of which 57.35%were carbapenem-resistant Klebsiella pneumoniae(CRKP)and 134(11.52%)were carbapenem-resistant Escherichia Coli(CRECO).CRE was mainly distributed in ICU(148 strains,12.73%),in intensive-care unit department of Neurology(NICU,96 strains,8.25%),in emergency department of intensive-care unit(EICU,87 strains,7.48%),mainly in respiratory specimens(587 strains,50.15%),and secondly in urine specimens(187 strains,16.11%).The results showed that CRKP was resistant to most of the antibiotics,while CRECO was sensitive to Amikacin,with a resistance rate of only 20.1%The resistance rates of carbapenem resistant enterobacter Cloacae to Levofloxacin and Ciprofloxacin were 30.6%and 41.8%,respectively.Conclusion The situation of CRE resistance is serious.The reasonable anti-infection treatment plan should be made according to the results of drug resistance monitoring in our hospital,and the implementation of infection control measures should be strengthened to reduce the emergence of drug-resistant bacteria.