158例碳青霉烯耐药肠杆菌科细菌的临床特点、酶型和耐药分析  

Clinical distribution,drug resistance profile and carbapenemases types of 158 carbapenem-resistant Enterobacteriale strains

作　　者：戴飘飘 王冬莲 俞莲花[1] 曲颖[1] 罗新华[1] DAI Piaopiao;WANG Donglian;YU Lianhua;QU Ying;LUO Xinhua(Department of Clinical Laboratory,Taizhou Municipal Hospital,Taizhou 318000,China)

机构地区：[1]台州市立医院检验科,318000 [2]台州医院检验科

出　　处：《浙江医学》2024年第23期2527-2530,共4页Zhejiang Medical Journal

基　　金：台州市社会发展类科技计划项目(22ywa43)。

摘　　要：目的探讨碳青霉烯耐药肠杆菌科细菌(CRE)的临床特点、产碳青霉烯酶型和耐药情况。方法回顾性选取台州市立医院2016年1月至2023年6月临床标本中分离出155例患者的158株CRE菌株,对其标本来源、科室分布、耐药情况进行分析。采用碳青霉烯酶抑制剂增强试验,对158株CRE菌株进行酶型分析。结果158例CRE菌株主要来源于痰液,占51.8%。主要分布在ICU(46.2%)、神经外科(12.0%)及泌尿外科(8.2%)。菌株中排名前3位分别为肺炎克雷伯菌(65.8%)、阴沟肠杆菌(12.0%)、产酸克雷伯菌(5.1%)。药敏试验显示,对替加环素(4.4%)和多黏菌素(9.4%)耐药率低,其次为头孢他啶/阿维巴坦(22.8%)。158株CRE菌株中产A类丝氨酸碳青霉烯酶110株(69.6%),产B类金属酶33株(20.9%),同时产A类丝氨酸碳青霉烯酶和B类金属酶7株(4.4%),其他酶型8株(5.1%)。结论CRE耐药性强,对多黏菌素和替加环素的敏感性高,以产A类丝氨酸碳青霉烯酶为主。头孢他啶/阿维巴坦对产A类丝氨酸碳青霉烯酶的肠杆菌科细菌有较好抗菌活性,不良反应少,效果好,敏感性较高,尤其肺炎克雷伯菌感染时推荐使用。Objective To investigate the clinical distribution,drug-resistance profile and carbapenemases types of carbapenem-resistant Enterobacteriaceae(CRE).Methods A total of 158 CRE strains from 155 patients were isolated from Taizhou Municipal Hospital from January 2016 to June 2023.The source of its specimens,departmental distribution,and drug resistance status were analyzed.The enzyme types of 158 CRE strains were identified using enhanced carbapenemase inhibitor test.Results The CRE strains were mainly isolated from sputum(51.8%),the specimens were most collected from ICU(46.2%),followed by neurosurgery department(12.0%)and urology department(8.2%).The top three species were Klebsiella pneumoniae(65.8%),Escherichia coli(12.0%),and Klebsiella oxytoca(5.1%).Drug susceptibility test results showed that these strains had a low resistance rate to tigecycline(4.4%),colistin(9.4%),followed by Ceftazidime/Avibactam(22.8%).Among the 158 CRE strains,110(69.6%)produced serine carbapenemase A,33(20.9%)produced metalloenzyme B,and 7(4.4%)produced both of carbapenemase A and metalloenzyme B,8(5.1%)had no carbapenemases production.Conclusion Carbapenem-resistant Enterobacteriales have strong drug resistance,but their sensitivity to polymyxin and tigecycline is high,and carbapenem-resistant Enterobacteriales strains mainly produce serine carbap-enemase.Ceftazidime/avibactam is recommended for clinical use due to its good activity against serine carbapenemase-producing Enterobacteriales,especially for Klebsiella pneumoniae infections.

关 键 词：肠杆菌科细菌 产碳青霉烯酶 肺炎克雷伯菌 头孢他啶/阿维巴坦 

分 类 号：R446.5[医药卫生—诊断学]