河南地区EICU革兰阴性菌感染的分布及耐药性、耐药基因分析  

Distribution,Drug Resistance and Resistance Gene of Gram-negative Bacteria Infections in EICU in Henan Area

作　　者：荆楠[1] 闫文娟[1] 楚亚菲 马冰[1] 马琼 李轶[1] JING Nan;YAN Wen-juan;Chu Ya-fei;MA Bing;MA Qiong;LI Yi(Henan Provincal People’s Hospital,Zhengzhou,Luoyang 450003,China)

机构地区：[1]河南省人民医院检验科

出　　处：《河南科技大学学报（医学版）》2019年第2期138-141,共4页Journal of Henan University of Science & Technology:Medical Science

摘　　要：目的探讨急诊重症监护病房(EICU)感染患者中革兰阴性菌分布及耐药性,分析相关耐药基因,为临床合理用药提供科学依据。方法对河南地区4家医院2014年1月至2017年12月EICU感染患者标本中的革兰阴性菌构成及药敏试验结果进行分析,聚合酶链反应(PCR)检测耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药基因blaKPC、blaIMP、blaNDM、blaVIM和blaOXA-48。结果共检出非重复革兰阴性菌828株,其中位居前3位的依次是鲍曼不动杆菌(33.82%,280/828)、肺炎克雷伯菌(24.15%,200/828)和大肠埃希菌(13.04%,108/828)。鲍曼不动杆菌中仅对替加环素和多黏菌素B耐药率低;肺炎克雷伯菌中CRKP为40.0%,且CRKP构成比由2014年的13.3%上升至2015、2016年的47.7%、50.0%,差异具有统计学意义(P=0.002,χ^2=12.620)。不同标本类型CRKP差异有统计学意义(P<0.001,χ^2=28.207)。80株CRKP中,67株携带blaKPC-2。结论EICU感染革兰阴性菌以鲍曼不动杆菌和肺炎克雷伯菌为主,且耐药情况严重。CRKP有增长趋势且具有标本差异性,主要耐药基因型为KPC-2。医院EICU应进一步加强监测,合理使用抗菌药物。Objective To explore the distribution and drug resistance of Gram-negative bacteria infections in emergency intensive care unit (EICU),and analyze the expressions of related drug resistance genes to provide scientific evidence for reasonable clinical treatment. Methods The distribution of Gram-negative bacteria from EICU infection and their antibiotic susceptibility were analyzed from January 2014 to December 2017.By polymerase chain reaction(PCR),the resistance genes,bla KPC,bla IMP,bla NDM,bla VIM and bla OXA-48 were detected in carbapene-resistant Klebsiella pneumoniae (CRKP). Results 828 non-repeating strains of gram-negative bacteria were isolated.The top three isolates were Acinetobacter baumannii (33.82%,280/828),Klebsiella pneumoniae (24.15%,200/828)and Eescherichia (13.04%,108/828).The drug resistance rate of Acinetobacter baumannii was low only to tigecycline and polymyxin B.The proportion of CRKP in Klebsiella pneumoniae was as high as 40.0%.The ratio of CRKP became higher,from 13.3% in 2014 to 47.7% in 2015 and 50.0% in 2016,which showed a significant difference( P =0.002,χ^2 =12.620).CRKP had statistic discrepancy in different specimens( P< 0.001,χ^2 =28.207).Of 80 CRKP isolates,there were 67 isolates carrying bla KPC-2. Conclusion Gram-negative bacteria in EICU were mainly Acinetobacter baumannii and Klebsiella pneumoniae with serious drug resistance situation.CRKP had a growing trend and specimen variability.The main drug resistance genotype is KPC-2.Monitoring of drug resi- stance should be strengthened to promote the rational use of antibacterials.

关 键 词：急诊重症监护病房 革兰阴性菌 耐药性 耐药基因 耐碳青霉烯类肺炎克雷伯菌 

分 类 号：R378[医药卫生—病原生物学]