摘要
目的分析耐碳青霉烯类肠杆菌科细菌(CRE)的临床分布及耐药性,为临床对CRE合理用药提供依据。方法对临床标本进行培养、分离和鉴定,采用BD Phoenix 100全自动细菌鉴定药敏检测系统进行鉴定及药敏分析,对耐碳青霉烯类肠杆菌科细菌采用改良Hodge方法进行碳青霉烯酶确证实验,亚胺培南和美罗培南药敏试验采用E试验进行复核,统计CRE的耐药情况和临床分布。结果 2016年共检出肠杆菌科细菌1 730株,其中CRE38株占2.20%,包括阴沟肠杆菌(ECL)9株占0.52%,大肠埃希菌(ECO)5株占0.30%,肺炎克雷伯菌(KPN)24株占1.39%。神经内科和ICU各8株均占21.05%,泌尿外科7株占18.42%,神经外科和康复科及呼吸内科各4株均占11.43%,肾内科2株占5.26%和内分泌科1株占2.86%。药敏结果显示:耐碳青霉烯类肠杆科细菌对复方新诺明的耐药率最低为7.9%,其次为阿米卡星57.9%,再为左氧氟沙星76.25%;对氨苄西林、氨苄西林/舒巴坦、哌拉西林、亚胺培南的耐药率分别为100%、94.5%、97.3%和94.8%。对碳青霉烯类抗生素美罗培南和亚胺培南耐药率:大肠埃希菌分别为100%、80%,肺炎克雷伯菌分别为83.4%、95.8%,阴沟肠杆菌分别为77.8%、100%。结论耐碳青霉烯类肠杆科细菌对多数临床常用抗菌药物呈高度耐药,严重限制临床抗感染治疗有效药物的选择。CRE菌株在ICU、脑科综合区和泌尿外科较为集中,应采取有效的感染防控措施以遏制此类耐药菌株的产生和播散。
Objective To analyze the clinical distribution and drug resistance of carbapenem resistant enterobacteri- aceae （ CRE）, and to provide evidence for clinical prevention and treatment of CRE. Methods We retrospectively analyzed the clinical infection specimens collected in our hospital in 2016, and identified the susceptibility test system of BD Phoenix 100 automatic bacterial identification. The modified Hodge method was used to confirm the carbapenemase Experiments, imi- penem and meropenem susceptibility test using E test review, statistics of drug resistance and clinical distribution of CRE. Re- suits A total of 1 730 strains of Enterobacteriaceae were detected in 2016, of which 2.20% were CRE 38 strains, including 0.52% of Enterobacter cloacae （ECL） , 0.30% of Escherichia coli（ECO） , 15 strains of Klebsiella pneumonia （KPN） , 24 strains accounted for 1.39%. 8 cases of neurology and ICU accounted for 21.05% , 7 cases of urology accounted for 18. 42% , neurosurgery, rehabilitation and respiratory medicine were 4 accounted for 11.43% , 2 cases of renal medicine ac- counted for 5.26% and 1 endocrine 2. 86%. The results showed that the lowest rate of resistance to the combination of neo- mycin was 7.9% , followed by amikaein 57.9% , and then levofloxacin 76. 25%. The sensitivity rates of Ampicillin, Ampi- cillin/sulbactam, Piperacillin, Beta - lactam and imipenem were 100% , 94. 5% , 97.3% and 94.8% , respectively. Resist- ance to carbapenem antibiotics meropenem and imipenem： Escherichia. coli were 100% , 80% ; Klebsiellepneumoniae were： 83.4% , 95.8%. Enterobacter cloacae were 77.8% and 100%. Conclusion Carbapenem - resistant Enterobacteriaceae is highly resisitant to most commonly used antimicrobial agents and severely limits the choice of effective anti - infective drugs CRE strains in the ICU, brain integrated area and urinary surgery is more concentrated. Effective prevention and control measures should be taken to curb the production and spread of such resistant strains.
出处
《现代医院》
2017年第12期1838-1840,1843,共4页
Modern Hospitals
关键词
耐碳青霉烯类
肠杆科细菌
耐药性
临床分布
Resistant Carbapenems
Enterobacteriaceae
Drug Resistance
Clinical Distribution
