摘要
目的了解我院耐碳青霉烯类肠杆菌科细菌(carbapenem resistant Enterobacteriaceae,CRE)分布特征以及耐药特点。方法采用Phoenix-100全自动细菌鉴定/药敏系统、联合纸片扩散法(K-B法)、改良Hodge试验及EDTA协同试验对我院2013—2017年CRE检出情况、感染特征、药敏试验及耐药性进行检测。结果共检出CRE菌株1020株,总检出率约为5.5%,改良Hodge试验阳性率为96.6%(985/1020)。2013—2017年CRE各年检出率依次为0.8%(24/2858)、8.6%(271/3156)、5.9%(249/4205)、6.2%(245/3935)、5.4%(231/4293);1020株CRE菌株以肺炎克雷伯菌988株(96.8%)为主,主要分离自呼吸道标本779株(76.2%)、血液标本87株(8.4%)、导管尖端45株(4.5%),主要来自重症医学科478株(46.9%)、神经内科重症病房315株(30.8%)。药敏试验结果显示:CRE菌株对庆大霉素、阿米卡星、复方磺胺甲噁唑、多黏菌素和替加环素的耐药率分别为53.2%、39.4%、45.9%、0和0,对其他临床常用抗菌药物的耐药率均高于97.5%;对庆大霉素耐药率由80%下降至48.3%;对复方磺胺甲噁唑耐药率由33.3%上升至60.0%;对多黏菌素和替加环素一直较敏感,未发现对多黏菌素和替加环素耐药的CRE菌株。结论 CRE菌株的分离率呈现出较高水平,其中以对碳青霉烯类耐药的肺炎克雷伯菌为主。我院流行的CRE菌株主要分离自重症医学科和神经内科重症病房,应对其感染的风险因素进行调查,并有针对性的采取感染预防措施进行防控。
Objective To investigate the distribution and the antibiotic resistance of carbapenem resistant Enterobacteriaceae （CRE）. Methods The detection, infection characteristics and drug resistance of CRE isolates were evaluated by the Phoenix-100 automatic bacterial identification/drug sensitivity system, the K-B method, the modified Hodge test, and the EDTA synergy test. Results A total of 1,020 clinical isolates of CRE were isolated from the clinical specimens of patients in our hospital. The detection rate of CRE was 5.5%, and the positive rate of the modified hodge test was 96. 6% （985/1,020）. The annual detection rates of CRE from 2013 to 2017 were 0.8% （24/2,858）, 8.6% （271/3,156）, 5.9% （249/4205）, 6.2% （245/3,935）, and 5.5% （231/4,293）, respectively. 1,020 clinical isolates of CRE mainly included 988 isolates （96.8%） of Klebsiella pneumoniae, among which 779 isolates were from respiratory tract specimens （76.2%）, 87 isolates were from blood specimens （8.4%） and 45 isolates were from catheter tips （4.5%）, 478 isolates were from the ICU department （46.9%） and 315 isolates were from NICU （30.8%）. Drug sensitivity test results showed that the resistance rates of CRE to gentamicin, amikacin, cotrimoxazole, polymyxin and tigecycline were 53.2%, 39.4%, 45.9%, 0 and 0, respectively. The resistance rate of CRE to other commonly used antibiotics was higher than 97.5%. The resistance rate to gentamicin decreased from 80% to 48.3%.The drug resistance rate of CRE to cotrimoxazole increased from 33.3% to 60%. The CRE was sensitive to polymyxin and tigecycline. So far, our hospital has not yet found the CRE which was resistant to polymyxin and tegicycline. Conclusion The isolation rate of CRE was increasing year by year, in which carbapenem-resistant Klebsiella pneumoniae was the main isolates. The prevalence of CRE in our hospital was mainly isolated from the ICU and NICU, and thus we should investigate the risk factors of CRE infections and take effective measures to contro
作者
张嫘
董爱英
汪亚斯
付玉冰
黄军祉
邢欢
王娜
Zhang Lei;Dong Ai-ying;Wang Ya-si;Fu Yu-bing;Huang Jun-zhi;Xing Huan;Wang Na(North China University of Science and Technology Affiliated Hospital, Tangshan 06300)
出处
《中国抗生素杂志》
CAS
CSCD
2018年第5期553-557,共5页
Chinese Journal of Antibiotics
关键词
碳青霉烯类耐药肠杆菌科细菌
感染
监测
分析
Carbapenem resistant Enterobacteriaceae
Infection
Surveillance
Analysis
