2019 年第 9 期 第 14 卷

耐碳青霉烯类抗菌药物肠杆菌科细菌的分离及耐药性分析

Isolation and drug resistance of carbapenem-resistant Enterobacteriaceae

作者：崔秀格吴忠伟王珊珊赵建平

英文作者：

单位：010010呼和浩特，内蒙古自治区人民医院检验科（崔秀格、赵建平）；010010呼和浩特，内蒙古医科大学内蒙古临床医学院2017级在读硕士研究生（吴忠伟、王珊珊）

英文单位：

关键词：耐碳青霉烯类抗菌药物肠杆菌科细菌；耐碳青霉烯类抗菌药物肺炎克雷伯菌；多重耐药

英文关键词：

• 摘要：

• 【摘要】目的    探讨耐碳青霉烯类抗菌药物肠杆菌科细菌（CRE）的分离率、标本来源和病区分布以及耐药情况。方法    收集2011年1月至2018年9月内蒙古自治区人民医院分离出的CRE 274株，分析不同菌种CRE的分离率、主要病区CRE的分离率和检出CRE的细菌类型、病区分布和标本来源，比较246株耐碳青霉烯类抗菌药物肺炎克雷伯菌（CR-KP）和2 771株非CR-KP对18种抗菌药物的耐药率，分析274株 CRE对18种抗菌药物的药敏试验结果。结果    CRE分离率为1.9%（274/14 476），其中CR-KP的分离率最高，为8.1%（246/3 040）。274株CRE中CR-KP 246株（89.8%）、耐碳青霉烯类抗菌药物阴沟肠杆菌15株（5.5%）、耐碳青霉烯类抗菌药物大肠埃希菌11株（4.0%）、耐碳青霉烯类抗菌药物产酸克雷伯菌2株（0.7%）；病区来源构成比最高为重症监护病房，占36.5%（100/274），其次为干部保健病房，占20.8%（57/274）；标本来源中痰液占43.4%（119/274）、尿液占32.5%（89/274）。246株CR-KP除对复方新诺明耐药率为78.9%外，对其他17种抗菌药物耐药率高达90.7%~100%，而2 771株非CR-KP对 18种抗菌药物的耐药率均低于35.9%，CR-KP对18种抗菌药物的耐药率均高于非CR-KP，差异均有统计学意义（均P<0.05）。274株CRE对18种抗菌药物的耐药率达80.3%~100%。结论    CRE分离率较高，病区分布主要为重症监护病房和干部保健病房，标本来源主要为痰液和尿液，CRE耐药分析结果呈多重耐药或广泛耐药，临床应加强消毒、隔离等预防工作并科学使用抗菌药物。

• 【Abstract】Objective    To investigate the isolation rate, specimen source, ward distribution and drug resistance of carbapenem-resistant Enterobacteriaceae(CRE). Methods    A total of 274 strains of CRE were isolated from January 2011 to September 2018 in Inner Mongolia People′s Hospital. Isolation rates of different CRE strains in main wards, specimen source and ward distribution were analyzed. Resistance rates of 246 strains of carbapenem-resistant Klebsiella pneumoniae（CR-KP）, 2 771 strains of non-CR-KP and 274 CRE strains to 18 kinds of antibacterial agents were analyzed. Results    CRE isolation rate was 1.9%(274/14 476); CR-KP isolation rate was 8.1%(246/3 040). Among 247 CRE strains, the constituent ratio of CR-KP was 89.8%(246); carbapenem-resistant Enterobacter cloacae accounted for 5.5%(15）; carbapenem-resistant Escherichia coli accounted for 4.0%(11）; carbapenem-resistant Klebsiella pneumoniae accounted for 0.7%(2）. The main ward source was intensive care unit(36.5%, 100/274) and cadre care unit(20.8%, 57/274). The main specimen source was sputum(43.4%, 119/274) and urine(32.5%, 89/274). Resistance rate of 246 CR-KP strains to compound sulfamethoxazole was 78.9%; resistance rates of CR-KP to the other 17 antimicrobials were 90.7%-100%. Resistance rates of 2 771 non-CR-KP strains to 18 antimicrobials were lower than 35.9%. Resistance rates of CR-KP were significantly higher than those of non-CR-KP(all P<0.05). Resistance rates of 274 CRE strains to 18 antimicrobials were 80.3%-100%. Conclusions    Isolation rate of CRE is high. The main ward source is intensive care unit and cadre health care unit; the main specimen source is sputum and urine. CRE resistance analysis shows multi-drug resistance or extensive resistance. It is necessary to strengthen prevention measures such as disinfection and scientific use of antibacterial drugs in clinical practice.