2013—2022年耐碳青霉烯类肠杆菌目细菌检出率的变化趋势及耐药性

Trends in the detection rate and antimicrobial resistance of carbapenem-resistant Enterobacterales, 2013-2022

摘要:

目的 分析耐碳青霉烯类肠杆菌目细菌(CRE)检出率的变化趋势及耐药性, 以指导临床合理使用抗菌药物。 方法 应用WHONET 5.6软件分析2013年1月—2022年12月某院就医患者CRE的分离率、标本来源、病区分布及耐药性。 结果 2013—2022年从该院就医患者的标本中共检出病原菌32 320株, 其中CRE 1 347株, CRE检出率为4.17%。CRE中居前三位者依次为耐碳青霉烯类肺炎克雷伯菌(CRKP)、耐碳青霉烯类大肠埃希菌(CREC)、耐碳青霉烯类阴沟肠杆菌(CRECL), 分别占78.10%(1 052株)、7.94%(107株)、7.80%(105株); 检出率分别为12.37%(1 052/8 504)、0.58%(107/18 407)、5.36%(105/1 960)。2022年CRE、CRKP、CREC和CRECL的检出率较2013年高(均P＜0.05), 且2018年检出率较2017年高(P＜0.05);其他时间段CRE和CRKP检出率有升高趋势, 但变化趋势平稳; CRECL检出率从2020年开始下降, 2021年较2020年下降明显(P＜0.05), 其他时间段CRECL检出率有升高趋势, 但变化趋势平稳。CRKP和CRECL的标本来源主要为下呼吸道, 其次为尿和血; CREC的标本来源主要为尿, 其次为下呼吸道和血。CRE的病区来源主要为干部保健病房、重症监护病房和神经外科。CRKP、CREC和CRECL对替加环素的耐药率均为0, 对氨基糖苷类药物(阿米卡星、妥布霉素和庆大霉素)的耐药率比较, CRECL最低(分别为3.81%、15.31%、32.65%), 其次为CREC(分别为34.58%、61.96%、65.22%), 最高为CRKP(分别为84.22%、87.06%、88.16%); CRECL对环丙沙星和左氧氟沙星的耐药率(82.86%~89.80%) 低于CRKP(97.72%~98.35%)和CREC(94.39%~97.83%)。CRKP、CREC和CRECL对美罗培南的耐药率分别为98.10%、83.65%、82.52%。 结论 CRE的检出率呈增长趋势, 且耐药情况严峻。临床医生应结合药敏试验结果合理选择抗菌药物, 采取有效措施降低CRE感染率。

Abstract:

Objective To analyze the trends and antimicrobial resistance of carbapenem-resistant Enterobacterales (CRE), and guide the rational use of antimicrobial agents in clinical practice. Methods WHONET 5.6 software was used to analyze the isolation rate, specimen source, ward distribution, and antimicrobial resistance of CRE in patients admitted to a hospital from January 2013 to December 2022. Results From 2013 to 2022, a total of 32 320 strains of pathogenic bacteria were detected from patient specimens collected at this hospital, among which 1 347 were CRE strains (4.17%). The top 3 detected CRE were carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CREC), and carbapenem-resistant Enterobacter cloacae (CRECL), accoun-ting for 78.10% (n=1 052), 7.94% (n=107), and 7.80% (n=105), respectively, the detection rates were 12.37% (1 052/8 504), 0.58% (107/18 407), and 5.36% (105/1 960), respectively. The detection rates of CRE, CRKP, CREC, and CRECL in 2022 were all higher than those in 2013 (all P < 0.05), and the detection rates in 2018 were higher than in 2017 (P < 0.05). The detection rates of CRE and CRKP showed an upward trend in other time periods, but the trend remained stable. The detection rate of CRECL started to decline since 2020, with a significant decrease in 2021 compared to 2020 (P < 0.05). While in other time periods, the CRECL detection rate has shown an upward trend with a stable pattern. The main source of specimens of CRKP and CRECL was respiratory tract, followed by urine and blood. The main source of CREC specimens was urine, followed by respiratory tract and blood. The main wards sources of CRE were cadre health care wards, intensive care unit, and department of neurosurgery. The resistance rates of CRKP, CREC, and CRECL to tigecycline were all 0. Comparison in the resistance rates of CRKP, CREC, and CRECL to aminoglycosides (amikacin, tobramycin, and gentamicin) showed that resistance rates of CRECL were the lowest (3.81%, 15.31%, 32.65%, respectively), followed by CREC (34.58%, 61.96%, 65.22%, respectively), and CRKP was the highest (84.22%, 87.06%, 88.16%, respectively). The resistance rates of CRECL to ciprofloxacin and levofloxacin (82.86%-89.80%) were lower than those of CRKP (97.72%-98.35%) and CREC (94.39%-97.83%). The resistance rates of CRKP, CREC, and CRECL to meropenem were 98.10%, 83.65%, and 82.52%, respectively. Conclusion The detection rate of CRE shows an increasing trend, and antimicrobial resistance is severe. Clinicians should choose antimicrobial agents rationally based on antimicrobial susceptibility test and take effective measures to reduce the infection rate of CRE.