Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.
Department of Clinical Laboratory, Medical Technology Institute of Xuzhou Medical University, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Antimicrob Agents Chemother. 2018 Jan 25;62(2). doi: 10.1128/AAC.01882-17. Print 2018 Feb.
Carbapenem-resistant (CRE) infection is highly endemic in China, but estimates of the infection burden are lacking. We established the incidence of CRE infection from a multicenter study that covered 25 tertiary hospitals in 14 provinces. CRE cases defined as carbapenem-nonsusceptible , , , or infections during January to December 2015 were collected and reviewed from medical records. Antimicrobial susceptibility testing and carbapenemase gene identification were performed. Among 664 CRE cases, most were caused by (73.9%), followed by (16.6%) and (7.1%). The overall CRE infection incidence per 10,000 discharges was 4.0 and differed significantly by region, with the highest in Jiangsu (14.97) and the lowest in Qinghai (0.34). Underlying comorbidities were found in 83.8% of patients; the median patient age was 62 years (range, 45 to 74 years), and 450 (67.8%) patients were male. Lower respiratory tract infections (65.4%) were the most common, followed by urinary tract infection (16.6%), intra-abdominal infection (7.7%), and bacteremia (7.7%). The overall hospital mortality rate was 33.5%. All isolates showed nonsusceptibility to carbapenems and cephalosporins. The susceptibility rate of polymyxin B was >90%. Tigecycline demonstrated a higher susceptibility rate against than against (90.9% versus 40.2%). Of 155 clinical isolates analyzed, 89% produced carbapenemases, with a majority of isolates producing KPC (50%) or NDM (33.5%)-type beta-lactamases among and The incidence of CRE infection in China was 4.0 per 10,000 discharges. The patient-based disease burden in tertiary hospitals in China is severe, suggesting an urgent need to enhance infection control.
耐碳青霉烯类肠杆菌科细菌(CRE)感染在中国高度流行,但感染负担的估计数据尚缺乏。我们通过一项覆盖中国 14 个省的 25 家三级医院的多中心研究,确定了 CRE 感染的发生率。2015 年 1 月至 12 月,从病历中收集并回顾性分析了耐碳青霉烯类抗生素、头孢菌素类药物不敏感的 CRE 感染病例。进行了抗菌药物敏感性检测和碳青霉烯酶基因鉴定。在 664 例 CRE 感染病例中,最常见的是肺炎克雷伯菌(73.9%),其次是大肠埃希菌(16.6%)和阴沟肠杆菌(7.1%)。每 10000 例出院患者中,CRE 感染的总发生率为 4.0,且不同地区差异显著,江苏省最高(14.97),青海省最低(0.34)。83.8%的患者存在基础合并症;中位患者年龄为 62 岁(范围为 45 至 74 岁),450 例(67.8%)为男性。下呼吸道感染(65.4%)最为常见,其次是尿路感染(16.6%)、腹腔内感染(7.7%)和菌血症(7.7%)。总的医院死亡率为 33.5%。所有分离株对碳青霉烯类和头孢菌素类药物均表现出耐药性。多黏菌素 B 的敏感性>90%。替加环素对 的敏感性高于对 的敏感性(90.9%对 40.2%)。在分析的 155 株临床分离株中,89%产生了碳青霉烯酶,其中 产生 KPC(50%)或 NDM(33.5%)-型β-内酰胺酶的比例最高。中国 CRE 感染的发生率为每 10000 例出院患者 4.0 例。中国三级医院的患者疾病负担严重,表明迫切需要加强感染控制。
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