2010—2016年耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分布及其耐药特征

Distribution and antimicrobial resistance of carbapenemresistant Klebsiella pneumoniae and Escherichia coli in 2010-2016

摘要:

目的了解临床分离的耐碳青霉烯类肺炎克雷伯菌（CRKP）及耐碳青霉烯类大肠埃希菌（CREC）的临床分布状况及耐药特征。方法回顾性分析某院2010年1月—2016年12月临床标本分离的肺炎克雷伯菌及大肠埃希菌，统计分析CRKP及CREC分离情况。结果2010—2016年7年共收集临床分离耐碳青霉烯类肠杆菌科细菌（CRE）310株（CRKP 268株，CREC 42株），CRKP检出率由2010年的1.33%上升到2016年的12.70%，呈逐年上升趋势（χ2=123.73，P＜0.01）；CREC检出率则处于相对稳定状态，2010—2016年均约为1.00%；标本来源和病区分布最多者分别为呼吸道标本（45.49％）和重症监护病房（31.93％）。药敏试验结果显示，CRKP和CREC除对阿米卡星耐药率稍低（分别为 80.60%、 38.10%）外，对大多数临床常用抗菌药物如第三代头孢菌素类、第四代头孢菌素类、β内酰胺类/酶抑制剂类、喹诺酮类等耐药率CRKP均＞90%、CREC均在80%左右，而非CRE菌株的耐药率低于CRE菌株（P<0.01）。结论7年间临床分离的CRKP的检出率呈现快速增加的趋势，几乎对常用抗菌药物均耐药，应予以高度关注。

关键词:

肺炎克雷伯菌; 大肠埃希菌; 耐碳青霉烯类肺炎克雷伯菌; 耐碳青霉烯类大肠埃希菌; 碳青霉烯酶; 耐药性; 抗药性, 微生物

Abstract:

ObjectiveTo understand the clinical distribution and antimicrobial resistance characteristics of clinically isolated carbapenemresistant Klebsiella pneumoniae (CRKP) and carbapenemresistant Escherichia coli （CREC）. MethodsClinically isolated Klebsiella pneumoniae and Escherichia coli from a hospital between January 2010 and December 2016 were analyzed retrospectively, isolation of CRKP and CREC were conducted statistical analysis. ResultsFrom 2010 to 2016, a total of 310 carbapenemresistant Enterobacteriaceae (CRE) isolates (268 were CRKP strains and 42 were CREC strains) were collected, isolation rate of CRKP increased from 1.33% in 2010 to 12.70% in 2016, showing an increasing trend year by year (χ2=123.73, P< 0.01); isolation rate of CREC was relatively stable, were all about 1.00% from 2010 to 2016. Most specimens were respiratory tract specimens (45.49%) and from intensive care unit (31.93%). Antimicrobial susceptibility testing showed that except resistance rates of CRKP and CREC were slightly lower to amikacin (80.60% and 38.10% respectively),  resistance rates of CRKP to most commonly used antimicrobial agents, such as third generation cephalosporins, fourth generation cephalosporins, βlactamase/lactamase inhibitors, and quinolones were all＞90%, resistance rates of CREC to above antimicrobial agents were all about 80%, resistance rate of nonCRE strains was lower than that of CRE strains (P<0.01). ConclusionDuring the past 7 years, detection rate of clinically isolated CRKP increased rapidly, were almost resistant to commonly used antimicrobial agents, which should be paid close attention.

Key words:

Klebsiella pneumoniae; Escherichia coli; carbapenemresistant Klebsiella pneumoniae; carbapenemresistant Escherichia coli; carbapenemase; drug resistance, microbial