某院耐碳青霉烯类肠杆菌科细菌的分布及耐药性分析  

Clinical Distribution and Drug Resistance of Carbapenem-resistant Enterobacteriaceae in Our Hospital

作　　者：李勇[1] 黄露萍[1] 晏坤[1] 任碧琼[1] LI Yong;HUANG Lu-ping;YAN Kun(The Second People's Hospital of Hunan Province,Changsha 410007)

机构地区：[1]湖南省第二人民医院,长沙410007

出　　处：《临床输血与检验》2018年第1期57-60,共4页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：湖南中医药大学省级优秀团队建设项目(No.1022-0001004013);湖南省第二人民医院重点专科基金(No.2012)资助

摘　　要：目的探讨耐碳青霉烯类抗菌药物肠杆菌科细菌(CRE)的分布及耐药性,为临床合理使用抗菌药物提供依据。方法收集临床分离的46株CRE,用改良Hodge试验检测碳青霉烯酶表型,用Vitek 2 Compact进行细菌鉴定、药敏试验;按CLSI 2012年标准判定药敏结果,用WHONET 5.6软件分析结果。结果 46株CRE以肺炎克雷伯菌为主,占82.61%;感染者主要来自ICU,占50.0%;感染部位以下呼吸道为主,占69.57%;其中38株改良Hodge试验阳性。分析近2年的CRE菌株耐药性,发现46株CRE中有9株泛耐药,泛耐药率达19.6%,且均出现在最近1年,对其他抗菌药的耐药率均在70%~100%。2014年9月~2015年9月收集到的CRE对氨基糖苷类药物阿米卡星、妥布霉素、庆大霉素的耐药率较2015年9月~2016年9月的CRE菌株大大升高(由原来的19.0%、23.8%和23.8%分别升高至88.0%、96.0%和96.0%),而对复方新诺明和呋喃妥因的耐药率略有降低(由原来的85.7%和100.0%分别降至65.8%和80.0%)。结论耐碳青霉烯类抗菌药物肠杆菌科细菌在医院重症监护病房相对集中,且呈多重耐药趋势,应加强耐药性监测,以药敏结果指导临床用药,有助于减少耐药菌株的出现。Objective To explore clinical distribution and drug resistance of carbapenem-resistant Enterobacteriaceae and provide basis for clinical rational use of antibiotics.Methods Carbapenemase phenotypes were detected in identified 46 CRE by modified Hodge test.The strains and their drug sensitivity tests were performed by VITEK-2 automatic bacteria identification system.The antimicrobial susceptibility results were evaluated according to CLSI 2012 standard and analyzed with WHONET 5.6 software.Results 8 2.6 1%of 4 6 CRE isolates were identified to be Klebsiella pneumoniae.Those infected patients were mainly from intensive care units(ICU),accounting for 50.0%,and infection site located at the lower respiratory tract(69.57%).A total of 38 stains from 46 isolated stains were positive in modified Hodge test.Analysis of the 46 CRE during last two years,we found that 9 of them were pan drug-resistant(19.6%),but the resistance rates of CRE isolates to other antimicrobial agents were all in 70%-100%,and all appear in this recent year.The resistant rates of the CRE in the year from September 2014 to September 2015 to aminoglycoside drug amikacin,tobramycin and gentamicin were dramatically increased to which from September 2015 to September 2016(from 19.0%,19.0%and 23.8%to 96.0%and 88.0%,96.0%respectively),and resistant rates to the Compound sulfamethoxazole and nitrofurantoin were slightly decreased(from 85.7%and 100%to 65.8%and 80%respectively).Conclusion The CRE isolates were mainly isolated from specimen of sputum in ICU and there was multiple drug resistance trend.The Drug resistance surveillance should be strengthened to guide the clinical medication and to reduce the emergence of drug resistant strains.

关 键 词：耐碳青霉烯类 肠杆菌科细菌 分布 耐药性 

分 类 号：R378.2[医药卫生—病原生物学] R969.3[医药卫生—基础医学]