我院肠杆菌科细菌对碳青霉烯类抗菌药物的耐药性分析
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摘要
目的:为临床合理使用碳青霉烯类抗菌药物提供参考。方法:收集我院2014年1月-2015年12月检出的肠杆菌科细菌,采用半自动微生物测定仪进行菌株培养、鉴定及药敏试验,采用改良Hodge试验和纸片扩散法进行产肺炎克雷伯菌碳青霉烯酶(KPC)和产超广谱β-内酰胺酶(ESBLs)耐药菌株的确证。结果:我院2014-2015年共检出肠杆菌科细菌1035株,其中大肠埃希菌732株,肺炎克雷伯菌157株、阴沟肠杆菌136株、黏质沙雷菌10株,未检出枸橼酸杆菌。大肠埃希菌和肺炎克雷伯菌对阿米卡星和碳青霉烯类抗菌药物的敏感率较高,而对大部分头孢菌素类抗菌药物的敏感率较低。共检出耐碳青霉烯类肠杆菌科细菌64株(6.18%),其中耐碳青霉烯类大肠埃希菌31株(4.23%)、耐碳青霉烯类肺炎克雷伯菌30株(19.11%)、耐碳青霉烯类阴沟肠杆菌1株(0.74%)、耐碳青霉烯类黏质沙雷菌2株(20.00%);耐药菌株主要来源于痰液和尿液标本,且主要集中于新生儿内科和重症医学科。64株耐药菌株中,产KPC的有59株(92.19%)、产ESBLs的有3株(4.69%)。结论:我院肠杆菌科细菌以大肠埃希菌为主,且耐碳青霉烯类大肠埃希菌和耐碳青霉烯类肺炎克雷伯菌的检出数量较多。肠杆菌科细菌对碳青霉烯类抗菌药物的耐药性可能与其产KPC和ESBLs有关。临床应遵循用药指征,结合药敏试验结果合理选用碳青霉烯类抗菌药物。
OBJECTIVE:To provide reference for rational use of carbapenem antibiotics in the clinic.METHODS:Enterobacteriaceae bacteria were collected from our hospital during Jan.2014-Dec.2015;semiautomatic microbiological assay instrument was used for strain culture,identification and drug sensitive tests.Modified Hodge test and K-B test were adopted to confirm Klebsiella pneumoniae carbapenemases(KPC)-producing and ESBLs-producing drug resistant strains.RESULTS:During 2014-2015,1 035 strains of Enterobacteriaceae bacteria were detected in our hospital,among which there were 732 strains of Escherichia coli,157 strains of K.pneumonia,136 strains of Enterobacter cloacae and 10 strains of Serratia marcescens.Citrobacter freundii was not found.E.coli and K.pneumonia were highly sensitive to amikacin and carbapenems,but slightly sensitive to most cephalosporin.A total of 64 strains of carbapenems-resistant Enterobacteriaceae bacteria(6.18%) were detected,among which there were 31 strains of carbapenems-resistant E.coli(4.23%),30 strains of carbapenems-resistant K.pneumonia(19.11%),1 strain of carbapenems-resistant E.cloacae(0.74%) and 2 strains of carbapenems-resistant S.marcescens(20.00%).The samples were mainly from sputum and urine specimens,which were mainly from neonatal department and ICU.Of 64 drug resistant strains,there were 59 KPC-producing strains(92.19%) and 3 ESBLs-producing strains(4.69%).CONCLUSIONS:E.coli occupies high proportion among Enterobacteriaceae bacteria,and the number of carbapenems-resistant E.coli and carbapenems-resistant K.pneumoniae is in high level.Drug resistance of Enterobacteriaceae bacteria to carbopenems may be associated with KPC and ESBLs producing.Carbapenem antibiotics should be selected rationally in accordance with medication indications and the results of drug sensitivity test.
OBJECTIVE:To provide reference for rational use of carbapenem antibiotics in the clinic.METHODS:Enterobacteriaceae bacteria were collected from our hospital during Jan.2014-Dec.2015;semiautomatic microbiological assay instrument was used for strain culture,identification and drug sensitive tests.Modified Hodge test and K-B test were adopted to confirm Klebsiella pneumoniae carbapenemases(KPC)-producing and ESBLs-producing drug resistant strains.RESULTS:During 2014-2015,1 035 strains of Enterobacteriaceae bacteria were detected in our hospital,among which there were 732 strains of Escherichia coli,157 strains of K.pneumonia,136 strains of Enterobacter cloacae and 10 strains of Serratia marcescens.Citrobacter freundii was not found.E.coli and K.pneumonia were highly sensitive to amikacin and carbapenems,but slightly sensitive to most cephalosporin.A total of 64 strains of carbapenems-resistant Enterobacteriaceae bacteria(6.18%) were detected,among which there were 31 strains of carbapenems-resistant E.coli(4.23%),30 strains of carbapenems-resistant K.pneumonia(19.11%),1 strain of carbapenems-resistant E.cloacae(0.74%) and 2 strains of carbapenems-resistant S.marcescens(20.00%).The samples were mainly from sputum and urine specimens,which were mainly from neonatal department and ICU.Of 64 drug resistant strains,there were 59 KPC-producing strains(92.19%) and 3 ESBLs-producing strains(4.69%).CONCLUSIONS:E.coli occupies high proportion among Enterobacteriaceae bacteria,and the number of carbapenems-resistant E.coli and carbapenems-resistant K.pneumoniae is in high level.Drug resistance of Enterobacteriaceae bacteria to carbopenems may be associated with KPC and ESBLs producing.Carbapenem antibiotics should be selected rationally in accordance with medication indications and the results of drug sensitivity test.
引文
[1]谭积善,邹自英,刘媛,等.我院肠杆菌科细菌对碳青霉烯类抗菌药物的耐药性分析[J].中国药房,2015,26(14):1942-1944.
[2]吴财铭,孙延生,栗俊杰,等.344株临床常见病原微生物分布及其耐药性分析[J].国际检验医学杂志,2011,32(8):851-852.
[3]Clinical and Laboratory Standards Institute.Performance standards of antimicrobial susceptibility testing[S].2013-01-30.
[4]卫生部医政司.全国临床检验操作规范[M].3版.南京:东南大学出版社,2006:378-379.
[5]裴保方,杨俊文,陈海燕,等.我院2010-2012年肠杆菌科细菌耐药性研究[J].中国药房,2013,24(46):4357-4359.
[6]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[7]王启,王辉,俞云松.2014年中国15家教学医院革兰阴性杆菌耐药性监测分析[J].中华内科学杂志,2015,54(10):837-845.
[8]王步补,阮战伟,项小婵,等.耐亚胺培南肺炎克雷伯菌分子流行病学及耐药传播机制研究[J].全科医学临床与教育,2014,12(1):18-22.
[9]李世杰,郭瑞娟,邢广栋,等.碳青霉烯耐药肠杆菌科细菌的耐药机制探讨[J].中国抗生素杂志,2012,37(8):623-627.
[10]谢小芳,沈海英,周惠琴,等.耐碳青霉烯类肠杆菌科细菌KPC-2与NDM-1基因的研究[J].中华医院感染学杂志,2014,24(11):2601-2606.
[11]Daikos GL,Markogiannakis A,Souli M,et al.Blood stream infections caused by carbapenemase-producing Klebsiella pneumoniae:a clinical perspective[J].Expert Rev Anti Infect Ther,2012,10(12):1393-1404.
[12]Tamma PD,Newland JG,Pannaraj PS,et al.The use of intravenous colistin among children in the United States:results from a multicenter,case series[J].Pediatr Infect Dis,2013,32(1):17-22.
[13]何颜霞.耐碳青霉烯类肠杆菌科细菌感染的治疗对策[J].中国小儿急救医学,2016,23(1):1-4.
[2]吴财铭,孙延生,栗俊杰,等.344株临床常见病原微生物分布及其耐药性分析[J].国际检验医学杂志,2011,32(8):851-852.
[3]Clinical and Laboratory Standards Institute.Performance standards of antimicrobial susceptibility testing[S].2013-01-30.
[4]卫生部医政司.全国临床检验操作规范[M].3版.南京:东南大学出版社,2006:378-379.
[5]裴保方,杨俊文,陈海燕,等.我院2010-2012年肠杆菌科细菌耐药性研究[J].中国药房,2013,24(46):4357-4359.
[6]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[7]王启,王辉,俞云松.2014年中国15家教学医院革兰阴性杆菌耐药性监测分析[J].中华内科学杂志,2015,54(10):837-845.
[8]王步补,阮战伟,项小婵,等.耐亚胺培南肺炎克雷伯菌分子流行病学及耐药传播机制研究[J].全科医学临床与教育,2014,12(1):18-22.
[9]李世杰,郭瑞娟,邢广栋,等.碳青霉烯耐药肠杆菌科细菌的耐药机制探讨[J].中国抗生素杂志,2012,37(8):623-627.
[10]谢小芳,沈海英,周惠琴,等.耐碳青霉烯类肠杆菌科细菌KPC-2与NDM-1基因的研究[J].中华医院感染学杂志,2014,24(11):2601-2606.
[11]Daikos GL,Markogiannakis A,Souli M,et al.Blood stream infections caused by carbapenemase-producing Klebsiella pneumoniae:a clinical perspective[J].Expert Rev Anti Infect Ther,2012,10(12):1393-1404.
[12]Tamma PD,Newland JG,Pannaraj PS,et al.The use of intravenous colistin among children in the United States:results from a multicenter,case series[J].Pediatr Infect Dis,2013,32(1):17-22.
[13]何颜霞.耐碳青霉烯类肠杆菌科细菌感染的治疗对策[J].中国小儿急救医学,2016,23(1):1-4.