耐碳青霉烯类抗生素肠杆菌科细菌的分布特点及耐药性
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摘要
目的了解肿瘤专科医院患者耐碳青霉烯类抗生素肠杆菌科细菌(CRE)感染情况和耐药性,以便为临床抗生素使用提供可靠依据。方法回顾收集江西省肿瘤医院2016年7月至2017年12月送检的18 000份标本中分离培养的39株CRE菌株,应用MicroScan Walkaway 40全自动细菌鉴定药敏分析仪进行鉴定及药敏试验。用Whonet5.6软件按照CLSI 2017-M100的折点标准统计分析。结果共分离出39株CRE菌株,其中大肠杆菌13株(33.3%),其次为阴沟肠杆菌12株(30.8%)、肺炎克雷伯菌8株(20.5%);CRE菌株主要分离自痰标本(13株,占33.3%),其次为尿液标本(10株,占25.6%)和腹水标本(6株,占15.4%);绝大部分CRE菌株对氨苄西林、头孢呋辛、头孢唑啉表现完全耐药,CRE菌株对头孢他啶、头孢曲松、头孢吡肟、头孢噻亏和头孢呋辛头孢菌素类抗菌药物表现出超高的耐药性(均达97.4%)。高于90%的分离株对哌拉西林/他唑巴坦(97.4%)、亚胺培南(100.0%)、美洛培南(97.4%)和复方新诺明(92.3%)不敏感(中介率加上耐药率),CRE对阿米卡星抗生素的敏感率达79.5%。结论 CRE引起患者感染已经很常见,病原菌耐药性严重且病情危重,临床应重视对CRE的分离和监测,并根据实验室检测结果合理选用抗生素。
Objective To understand the infection of Carbapenem-resistant Enterobacteriaceae(CRE) in patients with cancer at a specialty hospital and analyze the drug resistance, in order to provide a reliable basis for the use of antibiotics. Methods Thirty-nine CRE strains were collected and cultured from 18 000 specimens in Jiangxi Provincial Tumor Hospital between July 2016 and December 2017, which were then identified by MicroScan Walkaway 40 automatic microorganism identification and tested by drug sensitivity analyzer. Statistical analysis was performed using Whonet 5.6 software based on CLSI 2017-M100 Breakpoint Standard. Results Among the 39 CRE strains isolated, there were 13 strains of E. coli(33.3%), 12 strains of E. cloacae(30.8%), and 8 strains of Klebsiella pneumoniae(20.5%). The strains was mainly derived from sputum specimens(13 strains, accounting for 33.3%), followed by urine specimens(10 strains, 25.6%) and ascites specimens(6 strains, 15.4%). Almost all CRE strains exhibited 100% resistance to ampicillin,cefuroxime, and cefazolin, and high resistance to ceftazidime, ceftriaxone, cefepime, ceftazidime, and cefuroxime(all reached 97.4%). And more than 90% of the isolates were insensitive to piperacillin/tazobactam(97.4%), imipenem(100.0%), meropenem(97.4%), and cotrimoxazole(92.3%)(medium rate plus drug resistance rate). CRE was 79.5% sensitive to amikacin antibiotics. Conclusion Infection caused by CRE is very common in patients, and the resistance of pathogenic bacteria is serious. Clinical attention should be paid to the isolation and monitoring of CRE, and antibiotics should be reasonably applied according to laboratory test results.
Objective To understand the infection of Carbapenem-resistant Enterobacteriaceae(CRE) in patients with cancer at a specialty hospital and analyze the drug resistance, in order to provide a reliable basis for the use of antibiotics. Methods Thirty-nine CRE strains were collected and cultured from 18 000 specimens in Jiangxi Provincial Tumor Hospital between July 2016 and December 2017, which were then identified by MicroScan Walkaway 40 automatic microorganism identification and tested by drug sensitivity analyzer. Statistical analysis was performed using Whonet 5.6 software based on CLSI 2017-M100 Breakpoint Standard. Results Among the 39 CRE strains isolated, there were 13 strains of E. coli(33.3%), 12 strains of E. cloacae(30.8%), and 8 strains of Klebsiella pneumoniae(20.5%). The strains was mainly derived from sputum specimens(13 strains, accounting for 33.3%), followed by urine specimens(10 strains, 25.6%) and ascites specimens(6 strains, 15.4%). Almost all CRE strains exhibited 100% resistance to ampicillin,cefuroxime, and cefazolin, and high resistance to ceftazidime, ceftriaxone, cefepime, ceftazidime, and cefuroxime(all reached 97.4%). And more than 90% of the isolates were insensitive to piperacillin/tazobactam(97.4%), imipenem(100.0%), meropenem(97.4%), and cotrimoxazole(92.3%)(medium rate plus drug resistance rate). CRE was 79.5% sensitive to amikacin antibiotics. Conclusion Infection caused by CRE is very common in patients, and the resistance of pathogenic bacteria is serious. Clinical attention should be paid to the isolation and monitoring of CRE, and antibiotics should be reasonably applied according to laboratory test results.
引文
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[10]LIVERMORE DM,WARNER M,MUSHTAQ S,et al.What remains against carbapenem-resistant Enterobacteriaceae?Evaluation of chloramphenicol,ciprofloxacin,colistin,fosfomycin,minocycline,nitrofurantoin,temocillin and tigecycline[J].Int J Antimicrob Agents,2011,37(5):415-419.
[11]于亲德,徐平,于勇文,等.肺炎克雷伯菌介导致碳青霉烯类耐药的基因检测研究[J].海南医学,2014,25(17):2499-2502.
[2]DIENE SM,ROLAIN JM.Carbapenemase genes and genetic platforms in Gram-negative bacilli:Enterobacteriaceae,Pseudomonas and Acinetobacter species[J].Clin Microbiol Infect,2014,20(9):831-838.
[3]BRUST K,EVANS A,PLEMMONS R.Favourable outcome in the treatment of carbapenem-resistant Enterobacteriaceae urinary tractinfection with high-dose tigecycline[J].J Antimicrob Chemother,2014,69(4):2875-2876.
[4]PITOUT JD,LAUPLAND KB.Extended-spectrum beta-lactamase-producing Enterobacteriaceae:an emerging public-health concern[J].Lancet Infect Dis,2008,8(3):159-166.
[5]WANG Q,ZHANG Y,YAO X,et al.Risk factors and clinicaloutcomes for carbapenem-resistant Enterobacteriaceae nosocomialinfections[J].Eur J Clin Microbiol Infect Dis,2016,35(10):1679-1689.
[6]黄丹艳,史秋橙,蓝鹏,等.浙江地区碳青霉烯类耐药肺炎克雷伯菌分布、流行及耐药基因分析[J].中华传染病杂志,2018,36(1):7-11.
[7]NORDMANN P,DORTET L,POIREL L.Carbapenem resistance in Enterobact eriaceae:here is the storm[J].Trends Mol Med,2012,18(5):263-272.
[8]LOGAN LK.Carbapenem-resistant enterobacteriaceae:an emerging problem in children[J].Clin Infect Dis,2012,55(4):852-859.
[9]PATEL G,HUPRIKAR S,FACTOR SH,et al.Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies[J].Infect Control Hosp Epidemiol,2008,29(12):1099-1106.
[10]LIVERMORE DM,WARNER M,MUSHTAQ S,et al.What remains against carbapenem-resistant Enterobacteriaceae?Evaluation of chloramphenicol,ciprofloxacin,colistin,fosfomycin,minocycline,nitrofurantoin,temocillin and tigecycline[J].Int J Antimicrob Agents,2011,37(5):415-419.
[11]于亲德,徐平,于勇文,等.肺炎克雷伯菌介导致碳青霉烯类耐药的基因检测研究[J].海南医学,2014,25(17):2499-2502.