2019—2022年某医院耐碳青霉烯类肠杆菌科细菌分布特点及耐药情况分析

Distribution Characteristics and Drug Resistance of Carbapenem-resistant Enterobacteriaceae Bacteria in a Hospital from 2019 to 2022

目的:探讨2019—2022年某医院耐碳青霉烯类肠杆菌科细菌(CRE)的分布特点及耐药情况。方法:选取2019年1月—2022年12月南京市高淳人民医院非重复分离的7633株肠杆菌科细菌进行鉴定和药敏实验检测,统计分析CRE的分布特点及耐药情况。结果:7633株肠杆菌科细菌中,CRE菌株115株,占1.51%,包括肺炎克雷伯菌63株、黏质沙雷菌10株,大肠埃希菌35株,阴沟肠杆菌3株,产气肠杆菌3株,产酸克雷伯菌1株。115株CRE均分离自住院患者标本,其中重症监护室41株(35.65%),康复科22株(19.13%),肿瘤科12株(10.43%),呼吸科和其他科室各7株,泌尿外科、神经外科、普外科各6株,神经内科、感染科各3株,消化科2株。115株CRE分离自痰液42株,占比为36.52%,尿液41株,占比为35.65%,分泌物13株,占比为11.30%。肺炎克雷伯菌对头孢吡肟呈现出较高的耐药性,大肠埃希菌对哌拉西林呈现出较高的耐药性。黏质沙雷菌对氨苄西林、哌拉西林呈现出较高的耐药性,阴沟肠杆菌对头孢吡肟呈现出耐药性。产气肠杆菌对头孢吡肟、头孢他啶呈现出耐药性,产酸克雷伯菌对头孢他啶呈现出耐药性。结论:CRE以肺炎克雷伯菌、大肠埃希菌为主,CRE对多数常用抗菌药敏感率低。临床应做好医院感染监测,合理使用抗菌药,从而有效预防和控制耐药菌株的产生和传播。

Objective:To investigate the distribution and drug resistance of carbapenem-resistant enterobacteriaceae(CRE)bacteria in a hospital from 2019 to 2022.Method:A total of 7633 strains of Enterobacteriaceae from Nanjing Gaochun People's Hospital from January 2019 to December 2022 were selected for identification and drug sensitivity test,and the distribution characteristics and drug resistance of CRE were statistically analyzed.Result:Among the 7633 strains of Enterobacteriaceae,115 strains of CRE accounted for 1.51%,including 63 strains of Klebsiella pneumoniae,10 strains of Serratia marcescens,35 strains of Escherichia coli,3 strains of Enterobacter cloacae,3 strains of Enterobacter aerogenes and 1 strain of Klebsiella acidophilus.The 115 strains of CRE were isolated from hospitalized patients,including 41 strains(35.65%)in Intensive Care Unit,22 strains(19.13%)in Rehabilitation Department,12 strains(10.43%)in Oncology Department,7 strains each in Respiratory Department and other departments,6 strains each in Urology Department,Neurosurgery Department and General Surgery Department,3 strains each in Neurology Department and Infectious Department,and 2 strains in Gastroenterology Department.The 115 strains of CRE were isolated from sputum with 42 strains(36.52%),urine with 41 strains(35.65%)and secretion with 13 strains(11.30%).Klebsiella pneumoniae showed high resistance to Cefepime,and Escherichia coli showed high resistance to Piperacillin,Serratia marcescens showed high resistance to Ampicillin and Piperacillin,and Enterobacter cloacae showed high resistance to Cefepime,Enterobacter aerogenes showed resistance to Cefepime and Ceftazidime,and Klebsiella acidophilus showed resistance to Ceftazidime.Conclusion:Klebsiella pneumoniae and Escherichia coli are the main CRE,and the sensitivity rate of CRE to most commonly used antibiotics is low.Clinical surveillance of nosocomial infection should be done well,and antibiotics should be used rationally,so as to effectively prevent and control the production and spread of drug-resistant strains.