摘要
目的:分析本院2018~2020年临床不同部位来源的耐碳青霉烯类肠杆菌目细菌(CRE)的检出情况及耐药性,为临床合理使用抗菌药物提供依据。方法:采用标准纸片法或仪器法,按照统一技术方案,鉴定并完成细菌耐药性检测。药敏结果依据美国临床实验室标准化协会(CLSI)标准进行判读,采用WHONET 5.6分析数据。结果:2018~2020年共检出肠杆菌目细菌11389株,其中,检出CRE 1690株(14.84%),2018年657株、2019年555株、2020年478株,呈逐年下降趋势。2018~2020年CRE菌株排名前3位的均是肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌,共检出肺炎克雷伯菌1452株(占85.92%)、大肠埃希菌94株(占5.56%)、阴沟肠杆菌56株(占3.31%)。不同部位来源的肠杆菌目细菌中CRE的占比不同。其中,脑脊液中CRE的占比最高,连续3年均超过30%,且呈增长趋势;尿液中CRE占比最低,低于10%。未发现对替加环素耐药的CRE。CRE除对碳青霉烯类抗菌药物耐药外,对其他抗菌药物普遍耐药。对部分抗菌药物敏感的不同部位来源的CRE的耐药率不同。对部分抗菌药物敏感的碳青霉烯类耐药肺炎克雷伯菌的耐药率高于碳青霉烯类耐药大肠埃希菌与碳青霉烯类耐药阴沟肠杆菌。结论:CRE的检出率呈逐年下降趋势,构成和耐药性变化不大。不同部位来源的CRE检出率不同,检出的CRE耐药性不同,临床需结合CRE来源部位制定抗感染方案。
Objective:To analyze the detection and drug resistance of carbapenem-resistant Enterobacterales(CRE)from different clinical sites in our hospital from 2018 to 2020,so as to provide basis for rational clinical use of antibiotics.Methods:The standard paper method or instrument method was used to identify and complete the detection of bacterial drug resistance test according to the unified technical scheme.The results of drug sensitivity were interpreted according to the standards of Clinical and Laboratory Standards Institute(CLSI),and the data were analyzed by WHONET 5.6.Results:A total of 11389 strains of Enterobacterales were detected from 2018 to 2020,including 1690 strains of CRE(14.84%),657 strains in 2018,555 strains in 2019 and 478 strains in 2020,showing a downward trend year by year.From 2018 to 2020,the top three CRE strains were Klebsiella pneumoniae,Escherichia coli and Enterobacter cloacae.A total of 1452 strains of Klebsiella pneumoniae(85.92%),94 strains of Escherichia coli(5.56%)and 56 strains of Enterobacter cloacae(3.31%)were detected.The proportion of CRE in Enterobacterales from different sites was different.Among them,the proportion of CRE in cerebrospinal fluid is the highest,more than 30%for 3 consecutive years,and shows an increasing trend.The proportion of CRE in urine is the lowest,less than 10%.No CRE resistant to tigecycline was found.CRE is generally resistant to other antibiotics except carbapenem.The drug resistance rates of CRE sensitive to some antibiotics were different in different source sites.The drug resistance rate of carbapenem-resistant Klebsiella pneumoniae was higher than that of carbapenem-resistant Escherichia coli and carbapenem-resistant Enterobacter cloacae.Conclusion:The detection rate of CRE showed a downward trend year by year,with little change in composition and drug resistance.The detection rate of CRE from different sites is different,and the drug resistance of CRE detected is different,so it is necessary to formulate an anti-infection plan combined with the s
作者
张鸿娟
单斌
孟雪斐
宋贵波
苏艳丹
ZHANG Hong-juan;SHAN Bin;MENG Xue-fei;SONG Gui-bo;SU Yan-dan(Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Yunnan Medical Laboratory Clinical Research Center,Kunming 650032,China;Yunnan Innovation Team of Clinical Laboratory and Diagnosis,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)
出处
《中国合理用药探索》
2021年第10期81-88,共8页
Chinese Journal of Rational Drug Use
基金
科技部科技资源调查专项资助项目(2019FY101200,2019FY101209)。
