2013-2016年重庆市耐碳青霉烯类肠杆菌科细菌耐药性分析
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摘要
目的分析重庆地区2013-2016年耐碳青霉烯类肠杆菌科细菌(CRE)的分布特点及耐药性变迁,为临床治疗提供依据。方法分析2013-2016年重庆市分离出的4 694株非重复CRE菌株的耐药性,采用纸片扩散法或微量肉汤稀释法对上述菌株进行药敏试验,并按2016年版美国临床和实验室标准化协会标准判断药敏试验结果。结果 2013-2016年重庆市共分离非重复肠杆菌科细菌159 800株,其中CRE 4 694株,检出率为2.9%,且随年份增加检出率呈增高趋势,排名前3位的是肺炎克雷伯菌(1 748株,37.2%),大肠埃希菌(1 216株,25.9%)和阴沟肠杆菌(891株,19.0%);标本来源前3位的为呼吸道标本(2 521株,53.7%)、尿液标本(798株,17.0%)和血液标本(282株,6.0%)。CRE菌株在常规检测抗菌药物中对阿米卡星的耐药率最低,为23.2%,其次是复方磺胺甲噁唑、环丙沙星和庆大霉素,耐药率均低于60.0%(分别为55.4%、55.5%、56.3%),其余常规检测的抗菌药物耐药率均高于60.0%。结论重庆地区CRE菌株检出率较低,但有缓慢增加的趋势,应引起临床医生的足够重视。此外,应大力加强地区细菌耐药监测对临床的支撑力度,为临床合理使用抗菌药物提供强有力的指导。
Objective To investigate the distribution and antibiotic resistance of carbapenem-resistant Enterobacteriaceae(CRE)isolated in Chongqing from 2013 to 2016,in order to provide the basis for the clinical treatment.Methods A total of 4 694 clinical strains of CRE were collected from 2013 to 2016 in Chongqing.Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method.The results were analyzed according to CLSI 2016 breakpoints.Results During 2013-2016,totally159 800 strains of Enterobacteriaceae were separated,among which,4 694 strains were CRE,accounting for2.9%.The detection rate of CRE was increasing year by year,and the top three of CRE was Klebsiella pneumoniae(1 748 strains accounting for 37.2%),Escherichia coli(1 261 strains accounting for 25.9%)and Enterobacter cloacae(891 strains accounting for 19.0%).The 4 694 strains of CRE were mainly separated from respiratory tract(2 521 strains accounting for 53.7%),followed by urine(798 strains accounting for 17.0%)and blood(282 strains accounting for 5.7%).Drug sensitivity test results showed that the resistance rate of CRE to amikacin was the least,accounting for 23.2%,followed by compound sulfamethoxazole,ciprofloxacin and gentamicin were 55.4%,55.5% and 56.3%,the resistant rates to other antibiotics were almost more than60.0%.Conclusion The detection rate of CRE in Chongqing is low,but there is also increased slowly,which should cause enough attention in clinic.Therefore the support of resistance detection of regional bacteria should be enhanced to provide useful information for the clinical treatment.
Objective To investigate the distribution and antibiotic resistance of carbapenem-resistant Enterobacteriaceae(CRE)isolated in Chongqing from 2013 to 2016,in order to provide the basis for the clinical treatment.Methods A total of 4 694 clinical strains of CRE were collected from 2013 to 2016 in Chongqing.Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method.The results were analyzed according to CLSI 2016 breakpoints.Results During 2013-2016,totally159 800 strains of Enterobacteriaceae were separated,among which,4 694 strains were CRE,accounting for2.9%.The detection rate of CRE was increasing year by year,and the top three of CRE was Klebsiella pneumoniae(1 748 strains accounting for 37.2%),Escherichia coli(1 261 strains accounting for 25.9%)and Enterobacter cloacae(891 strains accounting for 19.0%).The 4 694 strains of CRE were mainly separated from respiratory tract(2 521 strains accounting for 53.7%),followed by urine(798 strains accounting for 17.0%)and blood(282 strains accounting for 5.7%).Drug sensitivity test results showed that the resistance rate of CRE to amikacin was the least,accounting for 23.2%,followed by compound sulfamethoxazole,ciprofloxacin and gentamicin were 55.4%,55.5% and 56.3%,the resistant rates to other antibiotics were almost more than60.0%.Conclusion The detection rate of CRE in Chongqing is low,but there is also increased slowly,which should cause enough attention in clinic.Therefore the support of resistance detection of regional bacteria should be enhanced to provide useful information for the clinical treatment.
引文
[1] FALAGAS M E,LOURIDA P,POULIKAKOS P,et al.Antibiotic treatment of infections due to carbapenem-resistant Enterobacteriaceae:systematic evaluation of the available evidence[J].Antimicrob Agents Chemother,2014,58(2):654-663.
[2] OLIVA A,D′ABRAMO A,D′AGOSTINO C,et al.Synergistic activity and effectiveness of a double-carbapenem regimen in pandrug-resistant Klebsiella pneumoniae bloodstream infections[J].J Antimicrob Chemother,2014,69(6):1718-1720.
[3] QI Y,WEI Z,JI S,et al.ST11,the dominant clone of KPC-producing Klebsiella pneumonia in China[J].J Antimicrob Chemother,2011,66(2):307-312.
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[5]郑恬,徐修礼,陈潇.肠杆菌科细菌耐药性及其耐碳青霉烯类菌株分布特点[J].中国感染控制杂志,2017,16(2):121-125.
[6]贾磊,余运贤,陆锦琪,等.某医院耐碳青霉烯类肠杆菌科细菌分布特征分析[J].预防医学,2017,29(8):799-800.
[7]叶丽艳,马艳宁,沈跃云,等.2008-2016年某医院耐碳青霉烯肠杆菌分布和药物敏感性分析[J].中国抗生素杂志,2017,42(5):408-412.
[8] PENA I,PICAZO J J,RODRIGUEZ-AVIAL C,et al.Carbapenemase-producing Enterobacteriaceae in a tertiary hospital in Madrid,Spain:high percentage of colistin resistance among VIM-1-producing Klebsiella pneumoniae ST11isolates[J].Int J Antimicrob Agents,2014,43(5):460-464.
[9] Hirsch E B,Tam V H.Detection and treatment options for Klebsiellapneumoniae carbapenemases(KPCs):an emerging cause of multidrug-resistant infection[J].J Antimicrob Chemother,2010,65(6):1119-1125.
[10]胡付品,朱德姝,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[11]Facility Guidance for Control of Carbapenem-resistant Enterobactervaceae(CRE).November 2015Update CRE Toolkit[EB/OL].http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf.
[12]周静芳,凌勇,刘伟江,等.耐碳青霉烯类肠杆菌科细菌的感染特征和危险因素分析[J].中华医院感染学杂志,2017,27(1):16-19.
[13]宁长秀,胡龙华,汪红,等.碳青霉烯类耐药肺炎克雷伯菌多位点序列分型研究[J].中国临床药理学杂志,2015,31(1):17-20.
[14]张广慧,曹雪萍,俞静,等.耐碳青霉烯鲍曼不动杆菌临床分离株的流行病学与耐药机制研究[J].检验医学,2015,30(1):53-57.
[15]田磊,陈中举,孙自镛,等.2005-2014年CHINET肠杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):275-283.
[16]CHEN K M,CHIANG M K,WANG M,et al.The role of pgaC in Klebsiella pneumonia virulence and biofilm formation[J].Microb Pathog,2014,77:89-99.
[17]SHON A S,BAJWA R P,RUSSON T A.Hypervirulent(hypermucoviscous)Klebsiella pneumonia:a new and dangerous breed[J].Virulence,2013,4(2):107-118.
[2] OLIVA A,D′ABRAMO A,D′AGOSTINO C,et al.Synergistic activity and effectiveness of a double-carbapenem regimen in pandrug-resistant Klebsiella pneumoniae bloodstream infections[J].J Antimicrob Chemother,2014,69(6):1718-1720.
[3] QI Y,WEI Z,JI S,et al.ST11,the dominant clone of KPC-producing Klebsiella pneumonia in China[J].J Antimicrob Chemother,2011,66(2):307-312.
[4] LERNER A,ADLER A,ABU-HANNA J,et al.Spread of KPCproducing carbapenem-resistant Enterobacteriaceae:the importance of super-spreaders and rectal KPC concentration[J].Clin MicrobiolInfect,2015,21(5):470.
[5]郑恬,徐修礼,陈潇.肠杆菌科细菌耐药性及其耐碳青霉烯类菌株分布特点[J].中国感染控制杂志,2017,16(2):121-125.
[6]贾磊,余运贤,陆锦琪,等.某医院耐碳青霉烯类肠杆菌科细菌分布特征分析[J].预防医学,2017,29(8):799-800.
[7]叶丽艳,马艳宁,沈跃云,等.2008-2016年某医院耐碳青霉烯肠杆菌分布和药物敏感性分析[J].中国抗生素杂志,2017,42(5):408-412.
[8] PENA I,PICAZO J J,RODRIGUEZ-AVIAL C,et al.Carbapenemase-producing Enterobacteriaceae in a tertiary hospital in Madrid,Spain:high percentage of colistin resistance among VIM-1-producing Klebsiella pneumoniae ST11isolates[J].Int J Antimicrob Agents,2014,43(5):460-464.
[9] Hirsch E B,Tam V H.Detection and treatment options for Klebsiellapneumoniae carbapenemases(KPCs):an emerging cause of multidrug-resistant infection[J].J Antimicrob Chemother,2010,65(6):1119-1125.
[10]胡付品,朱德姝,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[11]Facility Guidance for Control of Carbapenem-resistant Enterobactervaceae(CRE).November 2015Update CRE Toolkit[EB/OL].http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf.
[12]周静芳,凌勇,刘伟江,等.耐碳青霉烯类肠杆菌科细菌的感染特征和危险因素分析[J].中华医院感染学杂志,2017,27(1):16-19.
[13]宁长秀,胡龙华,汪红,等.碳青霉烯类耐药肺炎克雷伯菌多位点序列分型研究[J].中国临床药理学杂志,2015,31(1):17-20.
[14]张广慧,曹雪萍,俞静,等.耐碳青霉烯鲍曼不动杆菌临床分离株的流行病学与耐药机制研究[J].检验医学,2015,30(1):53-57.
[15]田磊,陈中举,孙自镛,等.2005-2014年CHINET肠杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):275-283.
[16]CHEN K M,CHIANG M K,WANG M,et al.The role of pgaC in Klebsiella pneumonia virulence and biofilm formation[J].Microb Pathog,2014,77:89-99.
[17]SHON A S,BAJWA R P,RUSSON T A.Hypervirulent(hypermucoviscous)Klebsiella pneumonia:a new and dangerous breed[J].Virulence,2013,4(2):107-118.