老年护理医院长期住院患者肠道耐碳青霉烯类肠杆菌携带分析  

Analysis of intestinal carryover of carbapenem-resistant Enterobacteriaceae in long-term inpatients in a geriatric care hospital

作　　者：李奇 薛坚 张泓[1] Li Qi;Xue Jian;Zhang Hong(Department of Clinical Laboratory,Children s Hospital of Shanghai City/Children s Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai,200062,P.R.China;Zhongren Geriatric Care Hospital,Jinshan District,Shanghai,201501,P.R.China)

机构地区：[1]上海市儿童医院/上海交通大学医学院附属儿童医院检验科,上海200062 [2]上海市金山区众仁老年护理医院检验科,上海201501

出　　处：《老年医学与保健》2023年第5期916-920,931,共6页Geriatrics & Health Care

基　　金：上海市科技创新行动计划(21S31901900);上海市金山区卫健委公卫项目(JSKJ-KTGW-2020-01)。

摘　　要：目的分析上海市金山区众仁老年护理医院长期住院者耐碳青霉烯肠杆菌(CRE)肠道携带情况,为临床防控CRE提供依据。方法于2021年4月选取上海市金山区众仁老年护理医院220例长期住院者(住院时间≥90 d)作为研究对象,收集患者的相关病史资料,使用CRE筛选平板筛选粪便中CRE,使用VITEK-2 Compact进行菌种的鉴定,采用碳青霉烯酶抑制增强实验检测CRE的耐药表型,用聚合酶链式反应(PCR)方法检测5种耐药基因(blaKPC、blaNDM、blaIMP、blaVIM和blaOXA-48),使用软件SAS 9.4进行数据的统计分析。结果220例患者中,CRE肠道携带者的所占比为8.18%(18/220),CRE以耐碳青霉烯大肠埃希菌、(CR-ECO)为主(9/18),其次为耐碳青霉烯肺炎克雷伯菌(CR-KPN)(6/18)。18株CRE均产碳青霉烯酶,blaNDM(11,61.11%)为主要产酶基因,其次为blaKPC(7,38.89%);blaNDM有blaNDM-1(8,44.44%)和blaNDM-5(3,16.67%)两种亚型,blaKPC的亚型均为blaKPC-2。18例肠道CRE携带者中,9例是长期使用留置胃管(>30 d)的患者,该类型患者最有可能是CRE的肠道携带者(P<0.05)。结论老年护理医院长期住院者中,有较高比例的CRE肠道携带者,肠道携带CRE的分子特征提示有耐药播散的风险,临床上应对入院者开展肠道CRE的携带筛查,采取适当的干预措施,降低CRE的传播风险。Objective To analyze the intestinal carryover of carbapenem-resistant Enterobacteriaceae(CRE)in long-term inpatients in Zhongren Geriatric Care Hospital in Jinshan District,and provide evidence for clinical prevention and control of CRE.Methods In April 2021,220 long-term inpatients(length of stay≥90 days)from Zhongren Geriatric Care Hospital were selected as the study subjects.Relevant medical history data of patients were collected.CRE in stool was screened by CRE screening plate,and strain identification was conducted by VITEK-2 Compact.The drug resistance phenotype of CRE was detected by carbapenem enzyme inhibition enhancement test,and five drug resistance genes(blaKPC,blaNDM,blaIMP,blaVIM and blaOXA-48)were detected by polymerase chain reaction(PCR).The software SAS 9.4 was used for statistical analysis of the data.Results Among 220 patients,the proportion of intestinal carrier of CRE was 8.18%(18/220),with carbapenem-resistant Escherichia coli(CR-ECO)being the main strain of CRE(9/18),followed by carbapenem-resistant Klebsiella pneumoniae(CR-KPN)(6/18).All 18 CRE strains produced carbapenemase,and blaNDM(11,61.11%)was the main enzyme producing gene,followed by blaKPC(7,38.89%).blaNDM has two subtypes:blaNDM-1(8,44.44%)and blaNDM-5(3,16.67%),and all subtypes of blaKPC were blaKPC-2.Among the 18 intestinal carrier of CRE,9 were patients who had been using indwelling gastric tubes for a long time(>30 d),and this type of patient was most likely to be an intestinal carrier of CRE(P<0.05).Conclusion There is a higher proportion of intestinal carrier of CRE among long-term inpatients in geriatric care hospitals.The molecular characteristics of CRE carried in the intestine suggest a risk of drug resistance spread.In clinical practice,screening for intestinal carrier of CRE should be carried out among hospitalized patients,and appropriate intervention measures should be taken to reduce the risk of CRE transmission.

关 键 词：耐碳青霉烯肠杆菌 长期住院 老年患者 肠道携带 

分 类 号：R446.5[医药卫生—诊断学]