深圳市某三甲医院CRE的临床分布与耐药性分析及CRE主动筛查重要性的讨论  

Epidemiological characteristics and drug resistance analysis of carbapenem resistant Enterobacteriaceae and importance of CRE active screening in a tertiary general hospital in Shenzhen

作　　者：樊冰[1] 艾辉[1] 张彦鹏[1] 聂勇波[1] 杜红霓 陈锐锋 周明 张洪[2] FAN Bing;AI Hui;ZHANG Yanpeng;NIE Yongbo;DU Hongni;CHEN Ruifeng;ZHOU Ming;ZHANG Hong(Shenzhen Second People's Hospital,Shenzhen,Guangdong 518035,China;Shenzhen Center for Prehospital Care,Shenzhen,Guangdong 518035,China)

机构地区：[1]深圳市第二人民医院检验科,广东深圳518035 [2]深圳市急救中心,广东深圳518035

出　　处：《中国医学工程》2022年第12期17-23,共7页China Medical Engineering

基　　金：广东省医学科学技术研究基金项目(B2019228)。

摘　　要：目的本研究回顾性分析深圳市第二人民医院近3年以来的耐碳青霉烯类肠杆菌(CRE)的临床分布情况与耐药性特点及对CRE的主动筛查重要性进行讨论,可为临床合理使用抗菌药物和院内感染防控提供理论依据。方法搜集整理2018年至2020年深圳市第二人民医院感染CRE住院病人的年龄、性别、科室、标本类型、具体菌种名称及其耐药性等基本信息。采用WHONET 5.6软件和SPSS 26.0软件进行数据分析,计算各研究指标的分布及构成比。结果2018年至2020年间共检出CRE病原菌289株。其中,男性患者检出率(193例,占66.8%)显著高于女性患者检出率(96例,占33.2%)。感染CRE的患者年龄组主要集中分布于40~79岁(209例,72.3%),60~79岁年龄组的检出率(111例,38.4%)最高,0~19岁年龄组的检出率(3例,1%)最低。289株CRE病原菌中肺炎克雷伯菌的分离率位于首位(226株,78.2%),其次分别为大肠埃希菌(25株,8.7%)、阴沟肠杆菌(19株,6.6%)、产气肠杆菌(5株,1.7%)。CRE病原菌的标本来源类型主要为呼吸道标本(122株,42.2%)、中段尿(97株,33.6%)和全血(32株,11.1%),其余标本类型CRE的分离率较低。各科室分离的CRE病原菌最主要分布于重症医学科(133株,46.0%)。其次神经重症监护室(42株,占14.5%)和康复医学科(40株,占13.8%)的分离率相比重症医学科较低,其余科室的CRE病原菌的占比均小于10%。分离出的289株CRE病原菌对各类常用抗菌药物的耐药率均有差异。对碳青霉烯类药物亚胺培南的耐药率三年均大于94%,且逐年升高。对美洛培南的耐药率由2018年的8.5%上升至2020年的75.7%,呈飞跃式升高;对头孢类药物(头孢他啶)耐药率呈先下降后上升趋势;对单环β-内酰胺类抗生素氨曲南的耐药率三年间均大于92%;对氨基糖苷类药物耐药率在48%~76%之间波动,对庆大霉素、广谱青霉素(氨苄西林)的耐药率呈下降趋势;对四环素类药物替加环素、米诺环素、�【Objective】To retrospectively analyze the clinical distribution and drug resistance characteristics of carbapenemresistant Enterobacteriaceae(CRE)in the hospital in the past three years and the importance of active screening of CRE,which can provide theoretical basis for the rational use of antibacterial drugs and nosocomial infection prevention and control.【Methods】Basic information on the age,gender,department,specimen type,specific bacterial name and drug resistance of inpatients infected with CRE in Shenzhen Second People's Hospital from 2018 to 2020 were collected and sorted.WHONET 5.6 software and SPSS 26.0 software were used for data analysis to calculate the distribution and composition ratio of each research index.【Results】A total of 289 strains of CRE pathogens were detected between 2018 and 2020.The detection rate of male patients(66.8%)was significantly higher than that of female patients(33.2%).Patients infected with CRE were mainly concentrated in the 40-79 age group(209,72.3%),with the highest detection rate(111,38.4%)and the lowest detection rate(1%)in the 0-19 age group.The separation rate of K.peumoniae in 289 CRE pathogens was in the first place(226 strains,78.2%),followed by E.coli(25 strains,8.7%),E.cloacae(19 strains,6.6%)and E.aerogenes(5 strains,1.7%).The main source types of CRE pathogens were tracheal extract(122 strains,42.2%),midstream urine(97 strains,33.6%),and total blood(32 strains,11.1%),and the separation rate of CRE in the remaining specimen types was low.CRE pathogens isolated in various departments were most mainly distributed in the department of intensive medicine(133 strains,46.0%).Secondly,the isolation rate of neurological intensive care unit(42 strains,14.5%)and rehabilitation medicine department(40 strains,13.8%)was lower than that of intensive care department,and the proportion of CRE pathogens in the rest of the departments was less than 10%.The resistance of 289 strains of CRE pathogens to various common antibacterial drugs varies.The resistance rate to t

关 键 词：耐碳青霉烯类肠杆菌 院内感染 流行特征 耐药性 主动筛查 

分 类 号：R446.1[医药卫生—诊断学]