2016年某三甲医院耐碳青霉烯肠杆菌科细菌阳性率及耐药性分析  

Positive rates and drug resistance of carbapenem-resistant Enterobacteriaceae strains isolated from a three-A hospital in 2016

作　　者：刘亚男[1] 李锐[1] 任晋宏[2] 王晨宇 郝素云[1] 石莹[1] LIU Ya-nan;LI Rui;REN Jin-hong;WANG Chen-yu;HAO Su-yun;SHI Ying(Affiliated Hospital of Logistics University of PAP,Infection Control Depant ment,2.Adasitting Department Tianjin 300163,China)

机构地区：[1]武警后勤学院附属医院感染控制科,天津300163 [2]武警后勤学院附属医院住院处,天津300163

出　　处：《中华医院感染学杂志》2018年第22期3365-3368,3377,共5页Chinese Journal of Nosocomiology

基　　金：武警后勤学院基础研究基金资助项目(WHJ201733)

摘　　要：目的对2016年耐碳青霉烯肠杆菌科细菌(CRE)分布及其耐药率进行回顾性分析,为规范临床抗菌药物使用,制定CRE防控措施提供依据。方法采用回顾性调查方法,对2016年送检的细菌培养标本中2 222例肠杆菌科细菌观察分析,对CRE的检出率、科室分布、ESBLs阳性率以及药敏试验结果进行系统分析。结果 CRE共检出433株,阳性率为19.49%(433/2 222),其中耐碳青霉烯的肺炎克雷伯菌(CRKp)占全部CRE的90.99%。ICU病区中CRKp、大肠埃希菌以及其他肠杆菌科细菌阳性率均高于外科系统和内科系统。ICU病区中CRKp阳性率为22.20%;神经ICU(18.05%)及综合ICU(4.07%)的CRKp检出率明显较高(P<0.05);神经外科CRKp及耐碳青霉烯的大肠埃希菌明显高于创伤科、泌尿外科和胃肠外科。无菌部位的样本中的CRKp阳性率明显高于大肠埃希菌及其他肠杆菌科细菌。CRE对碳青霉烯类(耐药率为100%)、头孢菌素类抗菌药耐药率高,仅对替加环素较敏感(敏感率>75%)。结论医院CRE(特别是CRKp)定植及流行趋势严峻。CRE对碳青霉烯类、三代及四代头孢菌素类、氨基糖苷类及喹诺酮类抗菌药物耐药明显,仅替加环素敏感性较高。应进一步加强对CRE的监测和感染控制,建议临床医生增加无菌部位标本的送检,并根据区域流行趋势及药敏试验结果,审慎选择抗菌药物。OBJECTIVE To retrospectively analyze the distribution and drug resistance rates of carbapenem-resistant Enterobacteriaceae strains isolated in 2016 so as to provide guidance for reasonable clinical use of antibiotics.METHODS By means of retrospective survey,totally 2222 strains of Enterobacteriaceae that were isolated from the submitted specimens in 2016 were observed.The isolation rates of CRE,distribution of departments,positive rate of ESBLs and result of drug susceptibility testing were statistically analyzed.RESULTS A total of 433 strains of CRE were isolated,with the positive rate 19.49%（433/2222）;the carbapenem-resistant Klebsiella pneumoniae（CRKP）strains accounted for 90.99% among the CRE strains.The positive rates of CRKP,Escherichia coli and other species of Enterobacteriaceae were higher in the ICU wards than in the surgical departments and internal medicine department.The positive rate of CRKP was 22.20%in the ICU wards;the isolation rate of CRKP was18.05%in the ICU of neurosurgery department,4.07%in the comprehensive ICU（P〈0.05）.The isolation rates of CRKP and carbapenem-resistant E.coli strains were remarkably higher in the neurosurgery department than in the trauma department,urology department and gastrointestinal surgery department.The positive rate of CRKP was remarkably higher than that of the E.coli and other species of Enterobacteriaceae in the specimens of sterile sites.The drug resistance rates of the CRE strains to carbapenems was 100%,and the strains were highly resistant to cephalosporins,and the drug susceptibility rate to tigecycline was more than 75%.CONCLUSIONThe CRE strains are highly prevalent and colonized in the hospital,especially the CRKP strains.The CRE strains are highly resistant to carbapenems,third and fourth generations cephalosporins,aminoglycosides and quinolones and are highly susceptible to tigecycline.It is necessary to further strengthen the surveillance of CRE and control of infection,increase of the submission rate of specimens of sterile sites and r

关 键 词：耐碳青霉烯肠杆菌科细菌 耐碳青霉烯的肺炎克雷伯菌 碳青霉烯类抗菌药物 耐药率 

分 类 号：R378[医药卫生—病原生物学]