摘要
目的了解某医院2014-2016年耐碳氢酶烯类肠杆菌科细菌(CRE)的临床分布与耐药性。方法选取某医院2014-2016年从临床标本中分离的137株CRE,采用WHONET5. 6和SPSS20. 0软件分析耐药性;采用改良碳氢酶烯酶灭活试验(m CIM试验)和改良Hodge试验检测碳氢酶烯酶。结果某医院2014-2016年共检出CRE 137株其中大肠埃希菌45株(32. 85%)、阴沟肠杆菌33株(24. 09%)、肺炎克雷伯菌27株(19. 71%)、柠檬酸杆菌14株(10. 22%)、其他细菌18株(13. 14%);标本检出主要是痰液58株(42. 34%)、尿液37株(27. 01%)、血液11株(8. 03%)、胆汁10株(7. 30%)、其他标本21株(15. 33%);科室分布主要是ICU26株(18. 98%)、普外22株(16. 06%)、泌尿外科16株(11. 68%)、脑外科12株(8. 76%)、干部病房(8. 76%)、康复医学科10株(7. 30%)、其他科室39株(28. 47%);除阿米卡星和妥布霉素耐药率分别为11. 56%和30. 67%外,CRE对临床常用的15种抗菌药物的耐药率均>40%; m CIM试验阳性37株,占CRE的27. 01%;改良Hodge试验阳性34株,占CRE的24. 82%。结论 CRE对多种常用抗菌药物耐药,无菌操作不当、长期住院使感染机会增加,重症及老年等免疫力低下的病人是易感人群,应引起高度重视,避免发生院内传播。
Objective To explore the distribution and drug resistance of carbapenem-resistant Enterobactericacea（ CRE） in a hospital during the period from 2014 to 2016.Methods A total of 137 strains of CRE were selected from the clinical isolated specimens and the drug resistance were analyzed with the software WHONET5. 6 and SPSS20. 0;mCIM test and modified Hodge test were applied in detecting the production of carbaprenemase. Results The 137 carbapenem-resistant Enterobacteriaceae isolated during the period from 2014 to 2017 included 45 strains of Escherichia coli（ 32. 85%）,33 strains of Enterobacter cloacae（ 24. 09%）,27 strains of Klebsiella pneumoniae（ 19. 71%）,14 strains of Citrobacter（ 10. 22%） and 18 strains of other strains（ 13. 14%）; 58 strains were separated from sputum（ 42. 34%）,37 strains from urine（ 27. 01%）,11 strains from wound（ 8. 03%）,10 strains from bile（ 7. 30%） and 21 strains from other specimens（ 15. 33%）; 26 strains were separated from ICU（ 18. 98%）,22 strains from department of general surgery（ 16. 06%）,16 strains from department of urinary surgery（ 11. 68%）,12 strains from department of cerebral surgery（ 8. 76%）,10 strains from department of rehabilitation medicine（ 7. 30%）,39 strains from other departments; the drug resistance of CRE to 15 antibiotics of clinical common application was over 40% except amikacin（ 11. 56%） and tobramycin（ 30. 67%）; mCIM test detected out 37 positive strains,taking up 27. 01% of CRE while modified Hodge test detected out 34 positive strains,taking up 24. 82% of CRE.Conclusions CRE is resistant to most antibiotics; inproper aseptic operation and long-term hospitalization increase the opportunity of infection; patients with low immunity,such as severe or aged,are susceptible population,and more attention should be given to avoid the occurrence of nosocomial transmission.
作者
王琴
邹自英
谭积善
刘媛
连丽莎
Wang Qin, Zou Ziying, Tan Jishan, Liu Yuan, Lian Lisha(Clinical Laboratory, Chengdu Military General Hospital, Chengdu, SichuanProvince, 610083, P. R. China)
出处
《西南军医》
2018年第5期516-519,共4页
Journal of Military Surgeon in Southwest China
