内科重症监护病房耐碳青霉烯肠杆菌定植情况及耐药性

Colonizationand drug resistance of carbapenem-resistant enterobacter in ICU of internal medicine

目的探究及分析某医院内科重症监护病房(ICU)住院患者耐碳青霉烯肠杆菌(CRE)定植情况及耐药情况,为重症监护室感控管理提供指导依据。方法对2017年3月至2018年12月某内科ICU新入院394例患者进行肛拭子CRE主动筛查760份标本,进行病原菌分离鉴定和抗菌药物敏感试验检测。结果病原菌分离鉴定为肛拭子筛查CRE阳性标本84份,肛拭子筛查CRE阳性率11.05%(84/760),检出CRE 101株,总检出率为15.63%(101/646)。其中耐碳青霉烯肺炎克雷伯菌的检出率最高为43.18%(76/176);其次为弗氏柠檬酸杆菌21.43%(3/14);阴沟肠杆菌20.00%(2/10);产气肠杆菌16.67%(1/6);大肠埃希菌4.79%(18/376);奇异变形杆菌2.33%(1/43)。抗菌药物敏感试验检测出不同碳青霉烯药物耐药率不同:厄他培南的耐药率最高为99.01%;亚胺培南耐药率为81.19%;美罗培南耐药率为80.20%。肛拭子CER阳性率和CRE检出率较部分文献差异有统计学意义(P<0.05)。结论本研究主动筛查CRE定植阳性较高,厄他培南、亚胺培南和美罗培南三种药物耐药率高,对加强CRE的集束化管理,防止CRE在院内发生感染提供参考依据。

Objective To explore and analyze the colonization and drug resistance of carbapenem-resistant enterobacter(CRE)in patients in internal medicine ICUand to provide guidance for infection control management in ICU.Methods Active anal swab screening for CRE was performed in 394 newly admitted patients in internal medicine ICUfrom March 2017 to December 2018.The isolation and identification of pathogenic bacteria and antimicrobial sensitivity testwere performed in 760 samples.Results Eighty-four positive specimens were detected from 760 samples with a positive rate of 11.05%(84/760).Furthermore,101 strains of CRE were detected with a total detection rate of 15.63%(101/646).The detection rate of carbapenem-resistant Klebsiellapneumoniae was the highest,accounting for 43.18%(76/176);followed by Citrobacterfreundii,21.43%(3/14),Enterobacter cloacae,20.00%(2/10);Enterobacter aerogenes,16.67%(1/6),Escherichia coli,4.79%(18/376),Proteus mirabilis 2.33%(1/43).Antimicrobial sensitivity test showed that the drug resistance rate of different carbapenems was varied as follows:etapenem(99.01%),imipenem(81.19%)and meropenem(80.20%).Conclusion There is high positive value of CRE in active screening,and high drug resistance rate of ertapenem,imipenem and meropenemin ICU of department of internal medicine.Therefore,cluster management of CRE is needed to prevent the outbreak of CRE and provide reference for preventing infection of CRE in hospital.