2008—2016年某医院耐碳青霉烯肠杆菌分布和药物敏感性分析  

Epidemiological characteristic analysis of the carbapenem-resistant Enterobacteriaceae in a hospital from 2008 to 2016

作　　者：叶丽艳[1] 马艳宁[1] 沈跃云[1] 马薇[1] 张有江[1] 杨继勇[1] 罗燕萍[1] 

机构地区：[1]解放军总医院微生物科,北京100853

出　　处：《中国抗生素杂志》2017年第5期408-412,共5页Chinese Journal of Antibiotics

基　　金：军队"十二五"重大课题分课题(No.AWS11C001)

摘　　要：目的了解2008—2016年我院临床分离的耐碳青霉烯肠杆菌(CRE)的分布特点和耐药情况,为控制和治疗此类细菌引起的感染提供依据。方法采用纸片扩散法(KB法)或VITEK 2 COMPACT全自动细菌鉴定药敏仪对上述菌株进行药物敏感性试验,按CLSI 2015-M100的标准进行药敏试验和结果分析。结果 2008—2016年我院自临床标本中共检出CRE菌株703株,CRE率检出率为3.1%,并呈逐年升高趋势。其中肺炎克雷伯菌537株,大肠埃希菌59株,肠杆菌属47株。标本来源最多为呼吸道标本(44.2%),且其分离率最高(5.0%),病房来源最多为监护病房(45.2%);分离率最高的科室是呼吸监护室(26.8%)。药敏试验结果显示,CRE对阿米卡星、复方磺胺甲噁唑和庆大霉素的耐药率分别为50.3%、53.1%和69.1%,对其他抗菌药物的耐药率>80%。其中,肺炎克雷伯菌较其他菌种的耐药性高,除阿米卡星、复方磺胺甲噁唑和庆大霉素外,对其他抗菌药物耐药率均>94%。结论 CRE菌株的分离数量呈现逐年升高的趋势,并对多数临床常用抗菌药物呈高度耐药。医疗机构应采取积极有效的感染控制措施以遏制此类菌株的大范围播散流行。Objective To provide the basis for the clinical control and treatment of such infections, we investigate the distribution and antibiotic resistance of carbapenem resistant Enterobacteriaceae（CRE） in clinical isolates from a hospital in Beijing during 2008-2016. Methods The drug sensitivity test was carried out with the method of disc diffusion （KB） or VITEK 2 COMPACT. Susceptibility tests and the result analysis according to the CLSI 2015-M100 standard. Results A total of 703 clinical isolates of CRE were isolated in 2008-2016, including 537 strains of Klebsiella pneumoniae, 59 strains of E. coli and 47 strains of Enterobacter spp. The detection rate of CRE was 3.1%, which was increasing year by year. The source and the distribution of the patients were the respiratory tract specimens （44.2%） and the ICU wards （45.2%）. The highest isolation rate was from the respiratory tract （5%） and respiratory care unit （26.8%）. Drug sensitivity test results showed that, the resistance rates of CRE to amikacin, cotrimoxazole and gentamicin were 50.3%, 53.1% and 69.1%, respectively. The resistant rates to other antibiotics were almost more than 80%. The resistance of carbapenem resistant Klebsiella pneumoniae was more serious than the average, but the resisitance of carbapenem resistant Escherichia coli and Enterobacter spp. were lower than the average level. Conelusion The strain of CRE was increasing year by year, and it was highly resistant to most of the commonly used antibiotics. Therefore we should take effective measures to control the infections to prevent the spread of such strains.

关 键 词：碳青霉烯 耐药 肠杆菌科 亚胺培南 美罗培南 

分 类 号：R978.1[医药卫生—药品]