耐碳青霉烯类肠杆菌科细菌临床感染现状分析  

Analysis of clinical infection status of carbapenem-resistant Enterobacteriaceae

作　　者：陆文香[1] 许倩[1] 钟桥[1] 徐卫东[1] 王亚南[1] 

机构地区：[1]苏州市立医院本部检验科,江苏苏州215002

出　　处：《国际检验医学杂志》2015年第13期1861-1863,共3页International Journal of Laboratory Medicine

摘　　要：目的了解该院临床分离的耐碳青霉烯类肠杆菌科细菌（CRE）的临床分布及产碳青霉烯酶情况。方法采用改良Hodge试验确认CRE菌株产碳青霉烯酶的情况,乙二胺四乙酸（EDTA）双纸片协同试验筛查CRE菌株产金属β-内酰胺酶情况,并对CRE菌株的临床分布作回顾性分析。结果该科室经仪器法筛查,标准琼脂扩散敏感试验（K-B法）复核证实,检出37株CRE菌株,检出菌株数从2012~2014年呈逐年递增趋势。从细菌种类看,耐碳青霉烯类菌株主要是肺炎克雷伯菌（16株）,其次是大肠埃希菌（6株）、黏质沙雷菌（6株）、阴沟肠杆菌（4株）。CRE菌株主要来源于重症监护室和老年病房。痰液、尿液、血液是检出CRE菌株的主要标本来源。经改良Hodge试验证实,36株CRE为产碳青霉烯酶菌株,其中肺炎克雷伯菌4株、阴沟肠杆菌3株、阿斯布肠杆菌1株,经EDTA协同试验筛查出产金属酶。结论有基础疾病的老年患者是CRE院内感染易感人群,是防控重点对象,该院CRE耐碳青霉烯类抗菌药物的主要机制是产生碳青霉烯酶,其中部分菌株产金属酶。Objective To investigate the clinical distribution of carbapenem-resistant Enterobacteriaceae（CRE）strains separated in this hospital and the situation of its production of carbapenem enzyme.Methods The production of carbapenem enzyme by CRE strains was confirmed by using modified Hodge test,the situation of the production of metallo-beta-lactamases by CRE strains was screened by using imipenem-EDTA double-disk synergy test,and the clinical distribution of CRE strains was retrospectively ana-lysed.Results 37 strains of CRE isolated in this laboratory were screened by using instrument method and verified by using disk diffusion （K-B）method.It showed an increasing trend from 2012 to 2014 in the amount of CRE strains.In terms of bacterial spe-cies,K.pneumonia（1 6 strains）was the main kind of carbopenems-resistant strains,followed by E.coli（6 strains）,Ser.marcescens（6 strains）and E.cloacae（4 strains）.CRE strains were mainly isolated from geriatric ward and intensive care unit（ICU）.Sputum,u-rine and blood specimen were key sources of CRE strains.Modified Hodge test confirmed that 36 strains of CRE were the strains that can produce carbapenemase,including 4 strains of K.pneumonia,3 strains of E.cloacae,and 1 strain of E.asburiae,and strains producing metallo-beta-lactamases were confirmed by using imipenem-EDTA double-disk synergy test.Conclusion Elderly patients with underlying diseases are susceptible population of CRE hospital infection and are primary preventive targets.The principal mechanism of carbapenem-resistant CRE strains in this hospital is the production of carbapenemase and production of metallo-β-lac-tamases in a small number of strains.

关 键 词：肠杆菌科 碳青霉烯类 改良HODGE试验 乙二胺四乙酸 协同试验 

分 类 号：R446.5[医药卫生—诊断学]