耐碳青霉烯肠杆菌在ICU和非ICU患者中的分布及耐药性研究
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摘要
目的回顾性分析本院ICU和非ICU肠杆菌分离及耐药情况,寻找2组患者在CRE检出率及耐药性上的异同。方法收集本院2017年住院患者分离的肠杆菌共1 821株,采用全自动细菌鉴定仪VITEK 2 Compact进行鉴定和药敏试验。结果 ICU主要标本的CRE检出率均显著高于非ICU(P<0.05),其中血标本差距最大(83.3%、12.4%)。ICU和非ICU中CRE的总分离率分别为42.8%、11.3%,差异有统计学意义(P<0.05),其中CRE阳性率最高的均是肺炎克雷伯菌,分别为73.6%、23.9%(P<0.05)。从ICU分离的大肠埃希菌敏感率最高的是替加环素(100.0%)、呋喃妥因(86.1%)、丁胺卡那(69.8%),非ICU则为替加环素(99.8%)、厄它培南(93.1%)、亚胺培南(92.3%);来源于ICU的肺炎克雷伯菌敏感率最高的是替加环素(87.3%)、庆大霉素(83.6%)、丁胺卡那(72.7%),而从非ICU分离的肺炎克雷伯菌则对替加环素(85.7%)、丁胺卡那(84.0%)、厄它培南(75.4%)敏感率最高。结论 ICU和非ICU中CRE的分布及耐药性具有显著差异,应依据细菌监测及药敏结果选择合适的抗生素并注意剂量和疗程,重视重点环节的防控。
Objective To retrospectively analyze isolation and drug resistance of Enterobacteriaceae of ICU and non ICU in our hospital, so as to find out the similarities and differences between the two groups in the detection rate and drug resistance of CRE. Methods 1 821 strains of Enterobacteriaceae isolated from our hospital in 2017 were collected. Identification and drug sensitivity test were carried out by automatic bacterial identification apparatus VITEK-2 Compact. Results The detection rate of CRE in ICU specimens was significantly higher than that in non ICU(P<0.05). The difference between blood samples were the largest(83.3%, 12.4%). The total isolation rate of CRE was 42.8%(ICU) and 11.3%(non ICU) respectively, and the differences were statistically significant(P<0.05). The highest positive rates of CRE were Klebsiellapneumoniae, respectively accounting for 73.6% and 23.9%(P<0.05). Escherichia coli isolated from ICU had the highest susceptibility rates to tigacycline(100%), furantoin(86.1%) and amikacin(69.8%), followed by tegafenone(99.8%), erapenem(93.1%), and imipenem(92.3%) in non ICU. The highest susceptibility rates of Klebsiellapneumoniae from ICU were resistant to tigacycline(87.3%), gentamicin(83.6%) and amikacin(72.7%), while those from non-ICU were resistant to tigacycline(85.7%), amikacin(84.0%) and ertapenem(75.4%). Conclusion There are significant differences in the distribution and drug resistance of CRE between ICU and non-ICU. Appropriate antibiotics should be selected according to the results of bacterial surveillance and drug susceptibility, and attention should be paid to dosage and course of treatment. We should pay attention to the prevention and control of key links.
Objective To retrospectively analyze isolation and drug resistance of Enterobacteriaceae of ICU and non ICU in our hospital, so as to find out the similarities and differences between the two groups in the detection rate and drug resistance of CRE. Methods 1 821 strains of Enterobacteriaceae isolated from our hospital in 2017 were collected. Identification and drug sensitivity test were carried out by automatic bacterial identification apparatus VITEK-2 Compact. Results The detection rate of CRE in ICU specimens was significantly higher than that in non ICU(P<0.05). The difference between blood samples were the largest(83.3%, 12.4%). The total isolation rate of CRE was 42.8%(ICU) and 11.3%(non ICU) respectively, and the differences were statistically significant(P<0.05). The highest positive rates of CRE were Klebsiellapneumoniae, respectively accounting for 73.6% and 23.9%(P<0.05). Escherichia coli isolated from ICU had the highest susceptibility rates to tigacycline(100%), furantoin(86.1%) and amikacin(69.8%), followed by tegafenone(99.8%), erapenem(93.1%), and imipenem(92.3%) in non ICU. The highest susceptibility rates of Klebsiellapneumoniae from ICU were resistant to tigacycline(87.3%), gentamicin(83.6%) and amikacin(72.7%), while those from non-ICU were resistant to tigacycline(85.7%), amikacin(84.0%) and ertapenem(75.4%). Conclusion There are significant differences in the distribution and drug resistance of CRE between ICU and non-ICU. Appropriate antibiotics should be selected according to the results of bacterial surveillance and drug susceptibility, and attention should be paid to dosage and course of treatment. We should pay attention to the prevention and control of key links.
引文
[1] 赵金云,许文芳,金法祥.ICU和非ICU患者感染肺炎克雷伯菌中超广谱β-内酰胺酶和碳青霉烯酶检测[J].中华医院感染学杂志,2018,28(2):165-168.
[2] 谢朝云,熊芸,孙静,等.ICU与非ICU肠杆菌科细菌的耐药性分析[J].中华医院感染学杂志,2015,25(5):998-1000.
[3] 由晓颜,孔繁荣,苏维奇.耐碳青霉烯类肠杆菌科细菌的临床分布特点及耐药性分析[J].中国卫生检验杂志,2017,27(4):601-603.
[4] Schwartz KL,Morris SK.Travel and the spread of drug-resistant bacteria[J].Curr Infect Dis Rep,2018,20(9):1-10.
[5] Lob SH,Hackel MA,Hoban DJ,et al.Activity of ertapenem against Enterobacteriaceae in seven global regions-SMART 2012-2016[J].Eur J Clin Microbiol,2018,37(8):1481-1489.
[6] 蒋伟,王思淼,金鑫.耐碳青霉烯类抗菌药物的肠杆菌科细菌耐药性与分子特征分析[J].中华医院感染学杂志,2017,27(8):1696-1698.
[7] Temkin E,Adler A,Lerner A,et al.Carbapenem-resistant Enterobacteriaceae:biology,epidemiology,and management[J].Ann N Y Acad Sci,2014,1323(1):22-42.
[8] 周旋,杜贵琴,李雅君,等.ICU和非ICU病房多重耐药菌检出及耐药性差异[J].中国感染控制杂志,2018,17(3):219-223.
[9] 徐网兰.ICU内不同部位肺炎克雷伯菌的耐药性及耐碳青霉烯类抗生素菌株感染的危险因素分析[D].杭州:浙江大学,2016.
[10] 魏立娜,陈兵,张清照,等.ICU与非ICU患者中心静脉导管感染调查[J].中华医院感染学杂志,2016,26(4):788-790.
[11] 庚俐莉,马海英.耐碳青霉烯类肺炎克雷伯菌感染患者的临床分析[J].中国现代药物应用,2016,10(24):96-97.
[12] Gheitani L,Fazeli H,Moghim S,et al.Frequency determination of Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from hospitals in Isfahan of Iran and evaluation of synergistic effect of colistin and meropenem on them[J].Cell Mol Biol,2018,64(1):70-74.
[13] van Duin D,Cober ED,Richter SS,et al.Tigecycline therapy for carbapenem-resistant Klebsiellapneumoniae (CRKP) bacteriuria leads to tigecyclineresistance[J].Clin Microbiol Infect,2014,20(12):1117-1120.
[14] 郑卫.氨基糖苷类抗生素研究的新进展[J].国外医药:抗生素分册,2005,26(3):101-110.
[2] 谢朝云,熊芸,孙静,等.ICU与非ICU肠杆菌科细菌的耐药性分析[J].中华医院感染学杂志,2015,25(5):998-1000.
[3] 由晓颜,孔繁荣,苏维奇.耐碳青霉烯类肠杆菌科细菌的临床分布特点及耐药性分析[J].中国卫生检验杂志,2017,27(4):601-603.
[4] Schwartz KL,Morris SK.Travel and the spread of drug-resistant bacteria[J].Curr Infect Dis Rep,2018,20(9):1-10.
[5] Lob SH,Hackel MA,Hoban DJ,et al.Activity of ertapenem against Enterobacteriaceae in seven global regions-SMART 2012-2016[J].Eur J Clin Microbiol,2018,37(8):1481-1489.
[6] 蒋伟,王思淼,金鑫.耐碳青霉烯类抗菌药物的肠杆菌科细菌耐药性与分子特征分析[J].中华医院感染学杂志,2017,27(8):1696-1698.
[7] Temkin E,Adler A,Lerner A,et al.Carbapenem-resistant Enterobacteriaceae:biology,epidemiology,and management[J].Ann N Y Acad Sci,2014,1323(1):22-42.
[8] 周旋,杜贵琴,李雅君,等.ICU和非ICU病房多重耐药菌检出及耐药性差异[J].中国感染控制杂志,2018,17(3):219-223.
[9] 徐网兰.ICU内不同部位肺炎克雷伯菌的耐药性及耐碳青霉烯类抗生素菌株感染的危险因素分析[D].杭州:浙江大学,2016.
[10] 魏立娜,陈兵,张清照,等.ICU与非ICU患者中心静脉导管感染调查[J].中华医院感染学杂志,2016,26(4):788-790.
[11] 庚俐莉,马海英.耐碳青霉烯类肺炎克雷伯菌感染患者的临床分析[J].中国现代药物应用,2016,10(24):96-97.
[12] Gheitani L,Fazeli H,Moghim S,et al.Frequency determination of Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from hospitals in Isfahan of Iran and evaluation of synergistic effect of colistin and meropenem on them[J].Cell Mol Biol,2018,64(1):70-74.
[13] van Duin D,Cober ED,Richter SS,et al.Tigecycline therapy for carbapenem-resistant Klebsiellapneumoniae (CRKP) bacteriuria leads to tigecyclineresistance[J].Clin Microbiol Infect,2014,20(12):1117-1120.
[14] 郑卫.氨基糖苷类抗生素研究的新进展[J].国外医药:抗生素分册,2005,26(3):101-110.