老年患者耐碳青霉烯类肠杆菌科细菌的感染变迁及耐药性

Distribution of carbapenem-resistant Enterobacteriaceae bacteria and its drug resistance isolated from elderly patients

目的分析老年病房耐碳青霉烯类肠杆菌科细菌(CRE)的感染变迁及耐药情况,为临床预防和治疗老年CRE感染提供参考依据。方法收集2017年1月-2022年10月解放军总医院第二医学中心60106岁老年患者送检标本中分离的肠杆菌科细菌,进行菌株鉴定和体外药敏试验,分析CRE的检出情况、变化趋势、标本来源、菌株构成、科室分布以及耐药性特点。结果肠杆菌科细菌中共检出CRE677株(32.27%),2017-2021年间医院CRE检出率整体呈现上升趋势;CRE菌株类型以肺炎克雷伯菌为主(占比75.48%),其次是大肠埃希菌(占比11.37%)和产气肠杆菌(占比7.98%),其中肺炎克雷伯菌CRE检出率最高,但无明显线性变化趋势,而后两者CRE检出率逐年上升且趋势明显;CRE菌株主要来源于呼吸道标本(61.30%);科室分布以呼吸科监护室检出率最高(45.87%);体外药物敏感性试验结果显示,CRE大多呈多耐药表型,三种主要耐药菌对青霉素类、头孢菌素类、β-内酰胺/β-内酰胺酶抑制剂复合物等多种药物耐药率>75%,替加环素、阿米卡星、磺胺甲噁唑/甲氧苄啶则保持相对较好的敏感性,但三种菌耐药特点各有不同。结论老年患者CRE检出率高,科室分布范围广,且对多数临床常用抗菌药物严重耐药,医院应加强老年CRE患者的早期识别和主动筛查、督促临床合理使用抗菌药物、强化CRE感染患者的接触预防、隔离及环境清洁等措施,减少CRE在老年病房的克隆传播和流行。

OBJECTIVE To analysis the changes of pathogenic distribution and drug resistance of carbapenem-resistance Enterobacteriaceae(CRE)bacteria isolated from elderly patients in our hospital,and to provide reference basis for clinical prevention and treatment of CRE infection in the elderly.METHODS Enterobacteriaceae bacteria isolated from specimens of elderly patients between 60 years old and 106 years old in the Second Medical Center of Chinese PLA General Hospital between Jan 1,2017 to Oct 31,2022.Strains were identified by VITEK-2 compact automatic microbial identification instrument and automatic biomass spectrum detector microfilex.Drug susceptibility test of Enterobacteriaceae bacteria was carried out in vitro by drug sensitive card and disk diffusion method.The detection rates,variation trends,specimen source,strain composition,departments'distribution and drug resistance of CRE were analyzed.RESULTS A total of 677(32.27%)CRE strains were isolated from Jan 1,2017 to Oct 31,2022,and the detection rates of CRE showed an overall increasing trend.Carbapenem-resistant Klebsiella pneumoniae(CRKP)was the main strain of CRE in our hospital(75.48%),followed by carbapenem-resistant Escherichia coli(CREC)(11.37%)and carbapenem-resistant Enterobacter aerogenes(CREA)(7.98%).The detection rate of CRKP was the highest but there was no obvious linear trend.However,the detection rates of CREC and CREA were obvious increased year by year and the trend is obvious.CRE strains were mainly isolated from respiratory tract specimens(61.30%),and the respiratory care unit had the highest detection rate(45.87%).Drug sensitivity test in vitro showed most of CRE stains were multi-drug resistant.The drug resistance rates of the main CRE to penicillins,cephalosporins andβ-lactam/β-lactamase inhibitor complexes were over 75%,while they had relatively good drug susceptibility to tigecycline,amikacin,tetracycline and trimethoprim/sulfamethoxazole.The drug resistance spectrum of the three strains of CRE were different.CONCLUSION The detection rate of CRE eld erly patients in our hospital is generally high,which are distributed in many departments and drug-resistant to most commonly used clinical antibiotics.Early identification and active screening of elderly CRE patients should be strengthened,and clinical department should rationally use of antibiotics.Measures including contact prevention,isolation and environmental cleaning should be carried out to reduce the infection of CRE in geriatric wards.