2013-2016年重庆市耐碳青霉烯类肠杆菌科细菌耐药性分析  

Analysis of drug resistance of carbapenem-resistent Enterobacteriaceae in Chongqing from 2013 to 2016

作　　者：王詝[1] 孙珊[1] WANG Zhu;SUN Shan(Department of Clinical Laboratory,the First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016

出　　处：《国际检验医学杂志》2019年第10期1165-1168,1173,共5页International Journal of Laboratory Medicine

基　　金：重庆市卫生和计划生育委员会课题资助项目(2017MSXM009)

摘　　要：目的分析重庆地区2013-2016年耐碳青霉烯类肠杆菌科细菌(CRE)的分布特点及耐药性变迁,为临床治疗提供依据。方法分析2013-2016年重庆市分离出的4 694株非重复CRE菌株的耐药性,采用纸片扩散法或微量肉汤稀释法对上述菌株进行药敏试验,并按2016年版美国临床和实验室标准化协会标准判断药敏试验结果。结果 2013-2016年重庆市共分离非重复肠杆菌科细菌159 800株,其中CRE 4 694株,检出率为2.9%,且随年份增加检出率呈增高趋势,排名前3位的是肺炎克雷伯菌(1 748株,37.2%),大肠埃希菌(1 216株,25.9%)和阴沟肠杆菌(891株,19.0%);标本来源前3位的为呼吸道标本(2 521株,53.7%)、尿液标本(798株,17.0%)和血液标本(282株,6.0%)。CRE菌株在常规检测抗菌药物中对阿米卡星的耐药率最低,为23.2%,其次是复方磺胺甲噁唑、环丙沙星和庆大霉素,耐药率均低于60.0%(分别为55.4%、55.5%、56.3%),其余常规检测的抗菌药物耐药率均高于60.0%。结论重庆地区CRE菌株检出率较低,但有缓慢增加的趋势,应引起临床医生的足够重视。此外,应大力加强地区细菌耐药监测对临床的支撑力度,为临床合理使用抗菌药物提供强有力的指导。Objective To investigate the distribution and antibiotic resistance of carbapenem-resistant Enterobacteriaceae(CRE) isolated in Chongqing from 2013 to 2016,in order to provide the basis for the clinical treatment.Methods A total of 4 694 clinical strains of CRE were collected from 2013 to 2016 in Chongqing.Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method.The results were analyzed according to CLSI 2016 breakpoints.Results During 2013-2016,totally 159 800 strains of Enterobacteriaceae were separated,among which,4 694 strains were CRE,accounting for 2.9 %.The detection rate of CRE was increasing year by year,and the top three of CRE was Klebsiella pneumoniae(1 748 strains accounting for 37.2%),Escherichia coli(1 261 strains accounting for 25.9%) and Enterobacter cloacae(891 strains accounting for 19.0%).The 4 694 strains of CRE were mainly separated from respiratory tract(2 521 strains accounting for 53.7%),followed by urine(798 strains accounting for 17.0%) and blood(282 strains accounting for 5.7%).Drug sensitivity test results showed that the resistance rate of CRE to amikacin was the least,accounting for 23.2%,followed by compound sulfamethoxazole,ciprofloxacin and gentamicin were 55.4%,55.5% and 56.3%,the resistant rates to other antibiotics were almost more than 60.0 %.Conclusion The detection rate of CRE in Chongqing is low,but there is also increased slowly,which should cause enough attention in clinic.Therefore the support of resistance detection of regional bacteria should be enhanced to provide useful information for the clinical treatment.

关 键 词：抗菌药 抗药性 肠杆菌科 碳青霉烯类耐药 

分 类 号：R446.5[医药卫生—诊断学] R378.2[医药卫生—临床医学]