东莞地区耐碳青霉烯类肠杆菌科细菌的临床分布及耐药性

Clinical distribution and antimicrobial resistance of carbapenemresistant Enterobacteriaceae in Dongguan

摘要:

目的了解东莞地区耐碳青霉烯类肠杆菌科细菌（CRE）的临床分布及其耐药性。方法回顾性分析2015年1月—2016年6月东莞市22所二级甲等及以上参加细菌耐药监测的医疗机构的住院患者分离的CRE菌株，应用WHONET 5.6软件进行耐药性分析。结果共检出CRE 71株，检出率0.34%（71/20 713）。CRE来源患者主要为15~60岁（53株，74.65%）；男性（46株，64.79%）；来源科室主要为重症监护病房（36株，50.70%）；来源标本主要为痰（34株，47.89%），其次为尿（11株，15.49%）、伤口分泌物（6株，8.45%）；感染类型主要为医院感染（64株，90.14%）；主要来源于三级医院（56株，78.87%）。三级医院CRE检出率为0.41%（56/13 677），二级医院为0.21%（15/7 036）。71株CRE对亚胺培南均耐药，对美罗培南耐药率81.12%，耐药率＜40%的药物仅有阿米卡星（21.38%）和妥布霉素（38.79%），对复方磺胺甲口恶唑的耐药率为48.23%，而对氟喹诺酮类、第三代头孢菌素及其含酶抑制剂等药物的耐药率均超过60%。结论东莞地区医疗机构CRE检出率低于全国及其他省份，应针对CRE检出的重点人群、科室采取有效预防控制措施，合理使用抗菌药物。

关键词:

耐碳青霉烯类肠杆菌; 抗菌药物; 药敏试验; 耐药性

Abstract:

ObjectiveTo investigate the clinical distribution and antimicrobial resistance of carbapenemresistant Enterobacteriaceae (CRE) in Dongguan. MethodsCRE isolated from hospitalized patients in 22 secondary and above medical institutions which participated in bacterial monitoring in Dongguan between January 2015 and June 2016 were retrospectively analyzed, antimicrobial resistance was analyzed by WHONET 5.6 software. ResultsA total of 71 CRE isolates were detected, with a isolation rate of 0.34% (71/20 713). 53 strains(74.65%) of CRE were isolated from patients aged 15-60 years old; 46(64.79%) were from male patients；CRE were mainly isolated from patients in intensive care unit(36 strains，50.70%）；the main specimen was sputum(34 strains, 47.89%），followed by urine （11strians，15.49%）and wound secretion（6 strains，8.45%）；the main infection type was healthcare associated infection (64 strains, 90.14%); CRE were mainly distributed in tertiary hospitals（56 strains，78.87%）, the isolation rate of CRE in tertiary and secondary hospitals were 0.41%（56/13 677）and 0.21%（15/7 036） respectively. 71 strains of CRE were all resistant to imipenem, resistance rate to meropenem was 81.12%， only amikacin and tobramycin had drug resistance rates of <40%( 21.38% and 38.79% respectively）, resistance rate to trimethoprim/sulfamethoxazole was 48.23%，while resistance rates to fluoroquinolones, thirdgeneration cephalosporins, and enzyme inhibitors were all>60. ConclusionThe isolation rate of CRE in Dongguan is lower than that of the whole nation and the other provinces, effective prevention and control measures should be taken according to the key population and departments that isolated CRE, antimicrobial use should be rational.

Key words:

carbapenemresistant Enterobacteriaceae; antimicrobial agent; antimicrobial susceptibility testing; drug resistance