近5年某三甲医院耐碳青霉烯类肠杆菌科细菌耐药性及分子流行病学研究  

Drug resistance and molecular epidemiology of carbapenem resistant Enterobacteriaceae bacteria in a tertiary hospital in the past 5 years

作　　者：朱文俊 王彦 刘霞 李明辉 吴月 胡娟 ZHU Wenjun;WANG Yan;LIU Xia;LI Minghui;WU Yue;HU Juan(Lianyungang Second People′s Hospital/the Affiliated Lianyungang Second People′s Hospital of Nanjing Medical University,Kangda College,Lianyungang,Jiangsu 222023,China)

机构地区：[1]连云港市第二人民医院/南京医科大学康达学院附属连云港第二人民医院,江苏连云港222023

出　　处：《国际检验医学杂志》2024年第24期3004-3009,共6页International Journal of Laboratory Medicine

基　　金：江苏省卫健委医学科研指导性项目(Z2022070);南京医科大学康达学院科研发展基金项目(KD2021KYJJZD029)。

摘　　要：目的分析2019-2023年某三甲医院临床分离的耐碳青霉烯类肠杆菌(CRE)的临床分布特点、耐药情况及其同源性,为临床合理用药和医院感染防控提供依据。方法回顾性分析2019-2023年该院临床分离的非重复CRE菌株,应用WHONET5.6软件分析CRE的检出率、临床分布特点及病原菌耐药性,并收集2022年该院临床分离的CRE菌株为研究对象,通过聚合酶链反应扩增及序列分析检测其耐药基因表达及医院内感染克隆株的同源性。结果2019-2023年该院临床标本中共检出非重复CRE 455株,检出率为6.00%,逐年分别为2019年72株(6.59%),2020年91株(8.31%),2021年117株(7.99%),2022年78株(4.76%),2023年97株(4.24%),2020-2023年,CRE检出率呈下降趋势(P<0.05)。CRE菌株中占比前两位的菌株分别为耐碳青霉烯肺炎克雷伯菌(CRKP)324株(71.21%),耐碳青霉烯大肠埃希菌(CREC)57株(12.53%),2021-2023年CRKP检出率呈下降趋势,2021-2023年CREC检出率呈上升趋势(P<0.05);菌株主要来自重症医学科、老年科及神经内科;其中大部分CRE菌株分离自痰标本,检出率为67.96%,其次是尿液标本,检出率为21.97%。CRE对临床常见的抗菌药物具有非常高的耐药性,对厄他培南、亚胺培南的耐药率分别为94.32%、96.37%。78株CRE菌株中共检测出bla_(KPC-2)基因型55株(70.51%),blaNDM基因型14株(17.95%);CRKP MLST分型ST11型检出率为68.89%(31/45)。结论该院CRE检出率呈下降趋势,但菌株耐药性仍然较高,CRE菌株中以CRKP为主,主要携带bla_(KPC-2)基因,且以ST11型为主,临床科室(尤其是重症医学科)应结合药敏试验结果合理选择抗菌药物进行治疗并加强医院内管理,进一步遏制CRE增长。Objective To analyze the clinical distribution characteristics,drug resistance,and homology of carbapenem resistant Escherichia coli(CRE)isolated from a tertiary hospital from^(2)019 to 2023,in order to provide a basis for rational drug use and hospital infection prevention and control.Methods A retrospective analysis was conducted on non repetitive CRE strains clinically isolated from^(2)019 to 2023 in the hospital.WHONET 5.6 software was used to analyze the isolation rate,clinical distribution characteristics,and pathogen resistance of CRE strains.CRE strains clinically isolated in 2022 in the hospital were collected as research objects,and the resistance gene expression and homology with hospital acquired infection clones were detected through polymerase chain reaction amplification and sequence analysis.Results From^(2)019 to 2023,a total of 455 non duplicated CRE strains were detected in clinical specimens of the hospital,with a detection rate of 6.00%.The annual detection rates were 72 strains(6.59%)in 2019,91 strains(8.31%)in 2020,117 strains(7.99%)in 2021,78 strains(4.76%)in 2022,and 97 strains(4.24%)in 2023.The CRE detection rates showed a downward trend from^(2)020 to 2023(P<0.05).The top two strains in terms of proportion among CRE strains were 324 strains(71.21%)of carbapenem resistant Klebsiella pneumoniae(CRKP)and 57 strains(12.53%)of carbapenem resistant Escherichia coli(CREC).In addition,the detection rate of CRKP showed a decreasing trend from^(2)021 to 2023,while the detection rate of CREC showed an increasing trend from^(2)021 to 2023(P<0.05).The strains mainly came from intensive care medicine,geriatrics,and neurology departments.Most of the CRE strains were isolated from sputum samples,with a detection rate of 67.96%,followed by urine samples with a detection rate of 21.97%.CRE had a very high resistance to common clinical antibiotics,with resistance rates of 94.32%and 96.37%to ertapenem and imipenem,respectively.Out of 78 strains of CRE,55 strains(70.51%)were found to have bla_(KPC-2)genotyp

关 键 词：耐碳青霉烯类肠杆菌 耐碳青霉烯肺炎克雷伯菌 耐碳青霉烯大肠埃希菌 临床流行分布 耐药特性 

分 类 号：R446.5[医药卫生—诊断学]