2018—2020年多中心耐碳青霉烯类肠杆菌目细菌的流行病学特征及耐药性分析  

Epidemiological characteristics and drug resistance analysis of multicenter carbapenem-resistant Enterobacterales from 2018 to 2020

作　　者：员静 单斌[2] 孟雪斐 张鸿娟[2] 马志刚 喻华[3] 耿荣华[4] 曲芬 刘平娟 刘家云 谢小芳[7] 蓝锴[8] 冀旭峰[9] 贾伟[10] 李刚[10] 鲍春梅 季萍[12] Yuan Jing;Shan Bin;Meng Xue-fei;Zhang Hong-juan;Ma Zhi-gang;Yu Hua;Geng Rong-hua;Qu fen;Liu Ping-juan;Liu Jia-yun;Xie Xiao-fang;Lan Kai;Ji Xu-feng;Jia Wei;Li Gang;Bao Chun-mei;Ji Ping(Urumqi Friendship Hospital,Urumqi 830049;The First Affiliated Hospital,Kunming Medical University,Yunnan Provincial Clinical Research Center for Laboratory Medicine,Kunming 650032;Sichuan Provincial People's Hospital,Chengdu 610072;General Aviation Hospital,Beijing 100012;The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080;The First Affiliated Hospital of Air Force Medical,Xi’an 710032;The Second Affiliated Hospital of Soochow University,Suzhou 215004;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120;The First Hospital of Jilin University,Changchun 130000;General Hospital ofNingxia Medical University,Yinchuan 750004;The Fifth Medical Center of PLA General Hospital,Beijing 100039;The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054)

机构地区：[1]乌鲁木齐市友谊医院,乌鲁木齐830049 [2]昆明医科大学第一附属医院云南省医学检验临床医学研究中心,昆明650032 [3]四川省人民医院,成都610072 [4]航空总医院,北京100012 [5]中山大学附属第一医院,广州510080 [6]空军军医大学第一附属医院,西安710032 [7]苏州大学附属第二医院,苏州215004 [8]广东省中医院,广州510120 [9]吉林大学第一医院,长春130000 [10]宁夏医科大学总医院,银川750004 [11]解放军总医院第五医学中心,北京100039 [12]新疆医科大学第一附属医院,乌鲁木齐830054

出　　处：《中国抗生素杂志》2021年第11期1038-1043,共6页Chinese Journal of Antibiotics

摘　　要：目的了解多中心耐碳青霉烯类肠杆菌目细菌的流行病学特征,为临床抗感染治疗提供依据。方法收集2018年1月—2020年12月全国不同地区11家医院6123株耐碳青霉烯类肠杆菌目细菌(carbapenem-resistant Enterobacterales,CRE)临床分离株,按统一方案和标准进行菌株鉴定和体外药物敏感性试验,药敏结果参照2020版CLSI标准判读,并用WHONET 5.6软件统计分析。结果3年间CRE检出率分别是6.4%(1897/29525)、6.8%(2186/32239)、7.3%(2171/29816),其中耐碳青霉烯类肺炎克雷伯菌(CR-KPN)、大肠埃希菌(CR-ECO)的3年总检出率分别是13.2%和2.0%。CRE菌株主要分离自痰液标本43.8%(2681/6123),其次是尿液标本16.0%(977/6123)、血液标本8.1%(496/6123)和分泌物标本4.5%(278/6123)。不同种属耐碳青霉烯类肠杆菌目细菌中不同标本类型的占比不同,CR-KPN以痰液标本为主,CR-ECO以尿液标本为主。不同科室的CRE检出率有所不同,以ICU检出最高。体外药敏结果显示,CRE对临床常用抗菌药物高度耐药,不同菌属CRE对临床常用抗菌药物的耐药率略有不同。CR-KPN和CP-ECO对大多数抗菌药物的耐药率高于耐碳青霉烯类阴沟肠杆菌(CR-ECL),对替加环素、多黏菌素B的体外抗菌活性较高。结论CRE检出呈上升趋势,各地区需加强本地区CRE监测,加强院内感染防控措施,有效遏制CRE的暴发流行。Objective To understand the epidemiological characteristics of multicentric carbapenem-resistant Enterobacterales bacteria,and provide a basis for clinical anti-infective treatment.Methods From January 2018 to December 2020,6,123 clinical isolates of CRE from 11 hospitals in different provinces across the country were collected.Strain identification and in vitro drug susceptibility tests were carried out according to uniform protocols and standards.The drug susceptibility results were interpreted according to the 2020 version of CLSI standards and used Statistical analysis of WHONET 5.6 software.Results The detection rates of CRE in the three years were 6.4%(1,897/29,525),6.8%(2,186/32,239),and 7.3%(2,171/29,816).Among them,the detection rates of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were 13.2%and 2.0%,respectively.CRE strains were mainly isolated from sputum specimens 43.8%(2,681/6,123),followed by urine 16.0%(977/6,123),blood specimens 8.1%(496/6,123)and secretion 4.5%(278/6,123).Different species of carbapenem-resistant Enterobacterales bacteria account for different specimen types.CR-KPN is mainly sputum specimens,and CR-ECO is mainly urine specimens..The detection rate of CRE is different in different departments,with ICU having the highest detection rate.In vitro drug susceptibility results show that CRE is highly resistant to clinically commonly used antibacterial drugs,and CRE of different bacterial species has different resistance rates to clinically commonly used antibacterial drugs.Carbapenem-resistant Klebsiella pneumoniae and Escherichia coli are more resistant to most antibacterial drugs than carbapenem-resistant Enterobacter cloacae,had high in vitro antibacterial activity against tigecycline and polymyxin B.Conclusion The detection of CRE is on the rise,and all regions need to strengthen the monitoring of CRE in the region,strengthen prevention and control measures for nosocomial infections,and effectively curb the outbreak of CRE.

关 键 词：耐碳青霉烯类肠杆菌目细菌 细菌耐药性监测 耐碳青霉烯类肺炎克雷伯菌 

分 类 号：R978.1[医药卫生—药品]