临床耐碳青霉烯类肠杆菌科细菌对头孢他啶/阿维巴坦的药物敏感性分析

Drug Sensitivity Analysis of Clinical Carbapenem-resistant Enterobacteriaceae Bacteria to Ceftazidime/Avibatan

目的分析携带不同碳青霉烯酶的耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)对头孢他啶/阿维巴坦(cerftazidime-avibactam,CZA)的药物敏感性,为临床合理精准用药提供依据。方法采用药敏纸片扩散法(K-B法)对烟台毓璜顶医院2018~2020年临床分离并保存的98株非重复CRE菌株进行CZA的药敏试验,并对CZA抑菌圈在20~22mm的菌株用微量肉汤稀释法(broth microdilution method,BMD)进行验证,聚合酶链反应(polymerase chain reaction,PCR)方法检测其碳青霉烯酶型,分析产不同碳青霉烯酶的CRE菌株对CZA的药物敏感性。结果烟台毓璜顶医院CRE菌株以产金属β-内酰胺酶为主,占72.45%,总体对CZA敏感率为23.47%。CZA对单产丝氨酸酶(bla_(KPC),bla_(OXA-48))的CRE敏感率为100%,对单产金属酶(bla_(NDM),bla_(VIM),bla_(IMP))的CRE耐药率为100%,对同时产丝氨酸酶和金属酶的CRE菌株和对不产酶的CRE菌株敏感率分别为25.0%和83.3%。结论携带不同碳青霉烯酶的CRE菌株对CZA的药物敏感性不同,CZA体外药敏试验有必要在临床开展,同时需增加酶型检测方法指导临床精准用药。

Objective To analyze the drug sensitivity of carbapenem-resistant Enterobacteriaceae(CRE)with different carbapenems to Cerftazidime-avibactam(CZA),and provide the basis for clinical rational and accurate drug use.Methods A total of 98 non-repeat CRE strains isolated and preserved in Yantai Yuhuangding Hospital from 2018 to 2020 were tested for CZA drug susceptibility by K-B method,and a broth microdilution method(BMD)was used for strains with CZA inhibition zone of 20~22mm,the polymerase chain reaction(PCR)method was used to detect the carbapenase type,and the sensitivity of CRE strains producing different carbapenases to CZA was analyzed.Results In Yantai Yuhuangding Hospital,the CRE strain was mainly metal-producingβ-lactamase,accounting for 72.4%,and the sensitivity rate to CZA was 23.5%.CZA was 100%sensitive to serinase(bla_(KPC),bla_(oxa-48)),100%resistant to metalase(bla_(NDM),bla_(VIM),bla_(IMP)),and the sensitivity rates of CRE strains producing serinase and metalloenzyme and CRE strain not producing enzyme were 25.0%and 83.3%,respectively.Conclusion CRE strains carrying different carbapenases had different drug sensitivity to CZA,so it is necessary to carry out CZA drug sensitivity test in vitro in clinic,and at the same time,enzyme type detection method should be added to guide clinical precision drug use.