247株耐碳青霉烯类肠杆菌目细菌的临床分布及耐药特性分析

Analysis on Clinical Distribution and Drug Resistance of 247 Carbapenem-resistant Enterobacteriaceae Bacteria

目的:了解我院耐碳青霉烯类肠杆菌目细菌(CRE)的临床分布及其耐药特性。方法:收集江西中医药大学附属医院2015年―2019年非重复临床分离肠杆菌目细菌,分析其中CRE的菌种分布和耐药特性;采用Micro Scan WalkAway-96全自动微生物分析仪进行细菌鉴定和药物敏感性试验,参照美国临床实验室标准化协会(CLSI 2019)标准判断结果,并将结果用Whonet5.6软件进行统计学分析,以此得到CRE菌株的耐药情况。结果:共收集7 806株肠杆菌目细菌,其中CRE菌株247株,分离率为3.2 %(247/7 806)。分离获得的CRE,主要是肺炎克雷伯菌102株(41.3 %)、产气肠杆菌51株(20.7 %)、大肠埃希菌38株(15.4 %)、阴沟肠杆菌23株(9.4 %)、产酸克雷伯菌7株(2.8 %);标本来源主要为尿液、痰液、分泌物、血液等;科室分布主要为外科、急诊科、心血管科、针灸科等;患者年龄分布情况为:6170岁、7180岁、8190岁。此三个年龄段的人数明显多于其他年龄人数,同时20岁以下和90岁以上患者人数相对较少;药敏情况为:CRE对氨苄西林、哌拉西林、哌拉西林/舒巴坦、头孢唑啉、头孢呋辛、头孢曲松、头孢噻肟、头孢吡肟呈现很高耐药率,皆达90 %以上,对厄他培南、亚胺培南、美罗培南和氨曲南的耐药率分别为95 %、84.9 %、91.3 %和89 %,对阿米卡星的耐药率相对较低,为50.1 %,均未发现对替加环素耐药的菌株。结论:我院CRE患者临床分布广泛,以老年患者居多,CRE患者对临床常用抗菌药物有较高耐药性,较大程度增加了治疗难度,应加强该菌的耐药性监测,合理使用抗生素,探索中药治疗途径,中西医并用,有效阻止耐药菌株的扩散和传播。

Objective:To understand the distribution and drug resistance characteristics of carbapenem resistant Enterobacteriaceae(CRE)in our hospital.Method:From 2015 to 2019,nonrepetitive clinical isolates of Enterobacteriaceae were collected from the affiliated hospital of Jiangxi university of Chinese medicine,and the distribution and drug resistance characteristics of CRE were analyzed Walkaway-96 automatic microbial analyzer was used for bacterial identification and drug sensitivity test,and the results were judged according to the standards of CLSI 2019,and the results were statistically analyzed with whonet5.6 software to get the resistance of CRE strain.Results:A total of 7 806 strains of Enterobacteriaceae were collected,including 247 CRE strains,with isolation rate of 3.2 %(247/7 806).Among the CRE isolates,Klebsiella pneumoniae has 102 strains,accounting for 41.3 %;enterobacter aerogenes has 51 strains,accounting for 20.7 %;escherichia coli has 38 strains,accounting for 15.4 %;enterobacter cloacae has 23 strains,accounting for 9.4 %;klebsiella acidogenes has7 strains,accounting for 2.8 %.From the perspective of specimen source,it is mainly urine,followed by saliva,secretion and blood;in terms of department distribution,it is mainly surgery,followed by emergency department,cardiovascular department and acupuncture department.According to the age distribution of patients,they are mainly aged 61 to 70,followed by aged 71 to 80 and aged 81 to 90.The number of patients in these three age groups is significantly higher than that in other age groups,while the number of patients under 20 and over 90 is relatively small.From the drug sensitivity results,CRE showed a high resistance rate to ampicillin,piperacillin,piperacillin/sulbactam,cefazolin,cefuroxime,ceftriaxone,cefotaxime and cefepime,all of which were over 90 %.The resistance rates to ertapenem,imipenem and meropenem,including aztreonam,were 95 %,84.9 %,91.3 % and 89 %,respectively.The resistance rate to amikacin was relatively low,no tegacyclin resistant strains were found.Conclusion:CRE patients in our hospital have a wide clinical distribution,most of them are middle-aged and elderly patients.CRE patients have high resistance to commonly used antibiotics,which greatly increases the difficulty of treatment.It is necessary to strengthen the monitoring of drug resistance of CRE,use antibiotics reasonably,explore the treatment of Traditional Chinese medicine,use traditional Chinese and western medicine,and effectively prevent the spread and spread of resistant strains.