近5年肺移植科及呼吸科患者细菌碳青霉烯酶分布及耐药调查  

The investigation of carbapenemase distribution and antibiotic resistance of bacterium from patients in the Lung Transplantation Department and the Respiratory Departments in the past five years

作　　者：李梦雪 李子尧 鲁炳怀 LI Meng-xue;LI Zi-yao;LU Bing-huai

机构地区：[1]中日友好医院呼吸中心,中国医学科学院呼吸病学研究所,国家呼吸医学中心,北京100029

出　　处：《中日友好医院学报》2023年第6期323-327,共5页Journal of China-Japan Friendship Hospital

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-030)。

摘　　要：目的:调查肺移植及呼吸病患者中分离的耐碳青霉烯肠杆菌目(CRE)的碳青霉烯酶分布及耐药情况。方法:收集北京某医院2017年6月—2021年5月肺移植科、呼吸科及重症呼吸科患者中分离的非重复CRE细菌(VITEK-2全自动分析鉴定仪检测),并用纸片扩散法复核药敏。采用碳青霉烯酶抑制增强试验及多重实时荧光PCR检测碳青霉烯酶基因及VITEK-2中的药敏结果。结果:本研究共纳入了肺移植科58株、呼吸科69株及重症呼吸科32株CRE菌株共3组标本。标本类型均以呼吸道来源为主(77.59%,78.26%,84.38%),分离的菌株中以肺炎克雷伯菌最为多见(72.41%,86.96%,84.38%),阴沟肠杆菌(10.34%,5.80%,6.25%)次之。肺移植科与呼吸科患者中碳青霉烯酶分布差异具有统计学意义,肺移植科金属酶检出比率高(27.59%vs11.59%,P<0.05);呼吸科患者中检出的丝氨酸酶较多(86.96%vs68.97%,P<0.05)。丝氨酸酶在3组患者标本的肺炎克雷伯菌中分布最为广泛(78.57%,91.67%,100%)。结论:呼吸道标本是分离CRE菌株的主要来源。菌株中均以产丝氨酸酶的肺炎克雷伯菌为主,且金属酶集中分布在大肠埃希菌及阴沟肠杆菌中。妥布霉素、阿米卡星及复方新诺明的敏感率稍高。Objective:To clarify the drug resistance of carbapenem-resistant Enterobacteriaceae(CRE)isolated from the patients in Lung Transplantation Department(LT),Intensive Respiratory Department(nLT-S)and Re-spiratory Department(nLT-nS)to carbapenem antibiotics.Methods:Non-repetitive CREs(detected by VITEK-2 automatic analyzer)were collected from patients in the three deparments in a hospital in Beijing from June 2017 to May 2021,and antibiotic sensitivity was rechecked by K-B(Kirby-Bauer)method.Carbapenemase inhi-bition enhancement test and multiplex real-time fluorescent PCR were used to detect the carbapenemase gene and the results of antibiotic sensitivity tested in VITEK-2.Results:A total of 58 CRE strains from the LT,69 CRE strains from the nLT-nS,and 32 CRE strains from the nLT-S were included in this study.The main types of specimens were respiratory specimens in the three groups(77.59%,78.26%and 84.38%).Among the bacteria isolated,Klebsiella pneumoniae was the most common one(72.41%,86.96%and 84.38%),followed by Enterobacter cloacae(10.34%,5.80%and 6.25%).There was a statistical difference in the distribu-tion of carbapenemases between the LT and the nLT-nS,and the detection rate of metalloenzymes(eg.NDM)in LT was relatively high(27.59%vs 11.59%,P<0.05),while more serinase(eg.KPC)was detected in nLT-nS(86.96%vs 68.97%,P<0.05).Serinase were most widely distributed in Klebsiella pneumoniae in all the three groups(78.57%,91.67%and 100%).Conclusion:Respiratory tract specimens were the main source of CRE in-fection isolates.KPC producing Klebsiella pneumoniae was the main strain,and NDM was concentrated in Esch-erichia coli and Enterobacter cloacae.The antibiotic sensitivity rates of tobramycin,amikacin and sulfamethoxa-zole were slightly higher.

关 键 词：耐碳青霉烯 肺移植 碳青霉烯酶分布 

分 类 号：R446.5[医药卫生—诊断学]