东莞地区耐碳青霉烯类肠杆菌科细菌的临床分布特点及耐药性分析

Clinical Distribution Characteristics and Drug Resistance Analysis of Carbapenem-resistant Enterobacteriaceae During in Dongguan

目的:了解东莞市2016-2020年耐碳青霉烯类肠杆菌科细菌(CRE)的临床分布特征,对其耐药性进行分析,为东莞地区抗菌药物使用和CRE防控策略提供研究基础。方法:从东莞地区细菌耐药监测网筛选2016-2020年期间收集的肠杆菌科细菌菌株,使用全自动微生物分析仪进行菌种鉴定和药敏试验,使用WHONET 5.6软件进行数据分析。结果:从东莞地区细菌耐药监测网筛选2016-2020年肠杆菌科细菌共88047株,其中CRE占0.98%,共864株;CRE检出率最高的为阴沟肠杆菌(3.77%),其次为肺炎克雷伯菌(2.14%);尿液标本(288株)、呼吸道标本(248株)和分泌物标本(117株)是CRE菌株的主要的来源标本,占其菌株检出总数的1.12%、1.55%、0.61%;CRE主要分布于重症医学科(15.39%);864株CRE药敏结果显示,替加环素的耐药率10.0%,其他耐药率均大于30%,864株CRE菌株中三种主要菌株的药敏结果显示,替加环素对三种主要菌株均有较好的敏感性。结论:CRE菌株分布广泛,医院内主要来源于重症医学科;呼吸系统和泌尿系统是CRE的高发生率部位。肺炎克雷伯菌和大肠埃希菌在CRE菌株中所占比例最高;临床大多数常用抗菌药物被CRE所耐受,建议医院加强预防意识,合理使用抗菌药物,全面有效地控制CRE的发生和扩散。

Objective To understand the clinical distribution characteristics of carbapenem-resistant enterobacteriaceae(CRE)in Dongguan city from 2016 to 2020,and analyze their drug resistance,so as to provide a research basis for the use of antibiotics and CRE prevention and control strategies in Dongguan.Methods The enterobacteriaceae bacterial strains collected from the drug resistance monitoring network in Dongguan during 2016-2020 were screened,and the species identification and drug sensitivity test were conducted by automatic microbiological analyzer,and data analysis was performed by WHONET 5.6 software.Results A total of 88047 enterobacteriaceae strains were screened from the drug resistance monitoring network in Dongguan from 2016 to 2020,864 strains were CRE accounted for 0.98%.The highest CRE detection rate was enterobacter cloacae(3.77%),followed by klebsiella pneumoniae(2.14%).Urine specimens(288 strains),respiratory tract specimens(248 strains)and secretions specimens(117 strains)were the main sources of CRE strains,accounting for 1.12%,1.55% and 0.61% of the total detected strains.CRE was mainly distributed in intensive care unit(15.39%).The drug sensitivity of 864 CRE strains showed that the drug resistance rate of tigecycline was 10.0%,and the drug resistance rate of other strains were more than 30%.The drug sensitivity of three main strains in 864 CRE strains showed that tigecycline had good sensitivity to the three main strains.Conclusion CRE strains are widely distributed,mainly from the intensive care department in the hospital;the respiratory system and urinary system are the high incidence sites of CRE.Klebsiella pneumoniae and Escherichia coli account for the highest proportions of CRE strains;most of the commonly used clinical antibiotics are tolerated by CRE.It is reecommended that hospitals strengthen the awareness of prevention,rationally use antibiotics,and comprehensively and effectively control the occurrence and development of CRE.