摘要
目的分析重症监护病房(ICU)患者碳青霉烯类耐药肺炎克雷伯菌(CRKP)分离株情况及耐药性,为CRKP的预防、控制及治疗提供更多参考依据。方法收集2019年1月-2022年1月新疆四七四医院ICU分离的CRKP菌株,采用mCIM和eCIM表型筛选试验对分离菌进行碳青霉烯酶筛选;用胶体金免疫层析法进行碳青霉烯酶基因分型;对其耐药性进行统计分析。结果2019年1月-2022年1月ICU的CRKP检出率10.5%,其中2019年检出率14.3%,2020年检出率13.8%,2021年检出率14.9%;主要分离于痰液标本28株,其次为血液4株、尿液5株、脑脊液2株,手术伤口分泌物1株。药敏结果显示40株CRKP菌株对氨曲南、头孢菌素类药物、β内酰胺类药物/β内酰胺酶抑制剂、喹诺酮类等药物,均有较高的耐药率≥97.5%,对氨基糖苷类药物耐药率为32.5%,替加环素耐药率7.5%、头孢他啶/阿维巴坦耐药率是5.0%,未发现对多黏菌素耐药菌株。碳青霉烯酶表型结果显示40株CRKP中碳青霉烯酶阴性2株,占比5%;产A类酶37株,占比92.5%;产B类酶1株,占2.5%。基因型测定中KPC型37株(占92.5)、NDM型1株(占2.5%),阴性2株。结论该院CRKP对多种抗菌药物耐药率高,耐药基因型以KPC为主,针对性加强重症监护病房清洁和院感监测,以更好的控制多重耐药菌的传播和流行。
Objective To analyze the isolation and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)in intensive care unit(ICU)patients,so as to provide more reference for the prevention,control and treatment of CRKP.Methods CRKP strains isolated from ICU of Xinjiang 474 Hospital,General Hospital of Xinjiang Military Command from January 2019 to January 2022 were collected.mCIM and eCIM phenotypic screening test were used to screen the isolates for carbapenemase,and colloidal gold immunochromatography was used for carbapenemase genotype.The drug resistance was statistically analyzed.Results The detection rate of CRKP in ICU from January 2019 to January 2022 was 10.5%,including 14.3%in 2019,13.8%in 2020 and 14.9%in 2021.28 strains were mainly isolated from sputum,followed by 4 strains from blood,5 strains from urine,2 strains from cerebrospinal fluid,and 1 strain from surgical wound secretion.Drug susceptibility results showed that 40 CRKP strains had high drug resistance rates≥97.5%to aztreonam,cephalosporins,β-lactam/β-lactamase inhibitors,quinolones and other drugs,32.5%to aminoglycosides,7.5%to tigecycline and 5.0%to ceftazidime/avibactam.No polycolistin resistant strains were found.The results of carbapenemase phenotype showed that there were 2 carbapenemase-negative strains(5%)in 40 CRKP strains.37 strains produced class A enzymes,accounting for 92.5%;1 strain produced class B enzyme,accounting for 2.5%.There were 37 strains(92.5)of KPC type,1 strain(2.5%)of NDMtype and 2 strains were negative.Conclusion The drug resistance rate of CRKP in this hospital is high,and the drug resistance genotype is mainly KPC.The cleaning of intensive care unit and hospital sensibility monitoring should be strengthened to better control the spread and prevalence of multi-drug resistant bacteria.
作者
张冬萍
沈璇
王萍
蒋瑞鑫
李娜
张雨婷
白冰
ZHANG Dongping;SHEN Xuan;WANG Ping;JIANG Ruixin;LI Na;ZHANG Yuting;BAI Bing(The 474 Hospital of Xinjiang,Urumqi,830000,China)
出处
《新疆医学》
2023年第11期1331-1334,共4页
Xinjiang Medical Journal
基金
新疆四七四医院项目(项目编号:2021jzbj1029)。
