宁波地区某医院2012—2022年耐碳青霉烯阴沟肠杆菌的临床分布及碳青霉烯酶种类变迁  

Clinical distribution of carbapenem-resistant Enterobacter cloacae and changes in carbapenemase enzyme types in a hospital in Ningbo,2012-2022

作　　者：岑叶平[1] 常燕子[2] 于纪棉[1] 俞佳 江玲丽[1] 陈兵华[2] CEN Yeping;CHANG Yanzi;YU Jimian;YU Jia;JIANG Lingli;CHEN Binghua(School of Medical Technology,Ningbo College of Health Sciences,Ningbo,Zhejiang 315100,China;Department of Clinical Laboratory,Ningbo Medical Center Li Huili Hospital,Ningbo,Zhejiang 315048,China;College of Biological and Environmental Sciences,Zhejiang Wanli University,Ningbo,Zhejiang 315100,China)

机构地区：[1]宁波卫生职业技术学院医学技术学院,浙江宁波315100 [2]宁波市医疗中心李惠利医院检验科,浙江宁波315048 [3]浙江万里学院生物与环境学院,浙江宁波315100

出　　处：《中国热带医学》2025年第1期95-102,共8页China Tropical Medicine

基　　金：浙江省教育厅一般科研项目(No.Y202353587);宁波市“科创甬江2035”关键技术突破计划项目(No.2024Z215);宁波卫生职业技术学院校级科研项目(No.2024Y01)。

摘　　要：目的分析宁波地区耐碳青霉烯阴沟肠杆菌(carbapenem-resistant Enterobacter cloacae,CR-ECL)的临床分布及碳青霉烯酶种类变迁,为指导临床抗菌药物合理应用提供依据。方法选取宁波地区某医院2012—2022年临床分离阴沟肠杆菌,用VITEK-2 COMPACT全自动微生物分析仪进行细菌鉴定和药物敏感试验,用VITEK MS质谱仪进行菌种确认;用E-Test方法确认CR-ECL;用碳青霉烯酶快速检测试剂盒和聚合酶链反应(PCR)检测CR-ECL携带碳青霉烯酶情况。结果宁波地区某医院2012—2022年共检出1428株ECL,其中36株CR-ECL,占2.52%;CR-ECL标本来源前3位是痰液(52.78%)、尿液(19.44%)和胆汁(13.89%),患者主要来自神经外科(22.22%)、普外科(13.89%)和ICU(11.11%);CR-ECL的检出率在不同性别和不同年龄组之间差异无统计学意义。CR-ECL对厄他培南、亚胺培南和美罗培南的耐药率分别为94.44%、58.33%和36.11%,对三/四代头孢菌素、氨曲南、酶抑制剂复合物、喹诺酮类的耐药率均在69.50%以上,显著高于非碳青霉烯耐药阴沟肠杆菌(non-carbapenem-resistant Enterobacter cloacae,NCR-ECL)菌株(P<0.05);对氨基糖苷类抗菌药物,CR-ECL和NCR-ECL均保持较低的耐药率(0%和0.22%)。在36株CR-ECL中,31株(86.11%)CR-ECL产碳青霉烯酶,检出酶型有NDM(28株,77.78%)、KPC(4株,11.11%)和IMP(2株,5.56%)3种,OXA-48和VIM未检出。碳青霉烯酶型快速检测和PCR检测结果符合率100%。结论宁波地区某医院2012—2022年CR-ECL检出率总体呈上升的波动趋势,分布于医院不同科室和多种标本,但在不同性别和年龄患者中的分布不存在差异;临床分离的CR-ECL以产NDM型碳青霉烯酶为主,但近年来也出现KPC和IMP等酶型,快速鉴定碳青霉烯酶型别对CR-ECL感染的临床治疗将起到重要指导作用。Objective To analyze the clinical distribution of carbapenem-resistant Enterobacter cloacae(CR-ECL)and changes in carbapenemase enzyme types in Ningbo and to provide a guide for the rational application of antibiotics in clinical practice.Methods Clinical isolates of CR-ECL were selected in a hospital in Ningbo from 2012 to 2022.Bacterial identification and drug sensitivity testing were performed using the VITEK-2 COMPACT automated microbiology system.Strain confirmation was conducted using the VITEK MS mass spectrometry system.The presence of CR-ECL was confirmed using the E-Test method.Carbapenemase production in CR-ECL was determined using a rapid carbapenemase detection kit and polymerase chain reaction(PCR).Results A total of 1428 isolates of ECL were detected in a hospital in Ningbo from 2012 to 2022,of which 36 strains were CR-ECL,accounting for 2.52%.The top three sample sources of CR-ECL were sputum(52.78%),urine(19.44%),and bile(13.89%).The patients were mainly from neurosurgery wards(22.22%),general surgery(13.89%),and ICU wards(11.11%).The separation rate of CR-ECL showed no significant difference between different genders and age groups.The resistance rates of CR-ECL to ertapenem,imipenem,and meropenem were 94.44%,58.33%,and 36.11%respectively.The resistance rates of CR-ECL to third/fourth generation cephalosporins,aztreonam,enzyme-inhibitor complexes,and quinolones were all above 69.50%,significantly higher than those of non-carbapenem-resistant Enterobacter cloacae(NCR-ECL)strains(P<0.05).For aminoglycosides,CR-ECL and NCR-ECL both maintained low resistance rates(0%and 0.22%,respectively).Among the 36 CR-ECL strains,31 strains(86.11%)were carbapenemase producers,including three types:NDM(28 strains,77.78%),KPC(4 strains,11.11%),and IMP(2 strains,5.56%).The other two carbapenemase types,OXA-48 and VIM,were not detected.The consistency rate between the rapid detection of carbapenem enzyme type and PCR detection was 100%.Conclusions The detection rate of CR-ECL in a hospital in Ningbo showed a trend o

关 键 词：阴沟肠杆菌 耐药性 碳青霉烯酶 宁波 

分 类 号：R446.5[医药卫生—诊断学]