Mohamed N A, Said H M, Hussin H, Abdul Rahman N, Hashim R
Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia.
Department of Pathology, Ampang Hospital, Selangor, Malaysia.
Trop Biomed. 2018 Jun 1;35(2):300-307.
Since its first discovery in 1996, Carbapenem-resistant Enterobactericeae (CRE) has been increasingly reported as a cause of infections particularly in immunocompromised patients. With limited treatment options, these multidrug-resistant organisms are associated with high mortality rates and are now recognized as an important cause of health-care associated infections. This study aimed to determine the prevalence of CRE at a 500-bedded tertiary hospital in Selangor, Malaysia. This study identified and analyzed CRE culture results from January 2015 to December 2016. The isolates were identified by conventional and Vitek 2® methods. Susceptibility tests were done by disk diffusion technique and confirmed by E-test. Polymerase chain reaction was performed to identify NDM-1, KPC, OXA-48, VIM and IMP genes. Demographic data and clinical characteristics were collected from the Hospital Information System. The prevalence of CRE in 2015 and 2016 was 0.3% (5/1590) and 1.2% (17/1402) respectively. 65% of the patients had underlying haematological disorders. Majority (81.8%) of the isolates were Klebsiella pneumoniae, followed by Serratia marcescens, Escherichia coli, and Citrobacter koseri. Klebsiella pneumoniae that co-produced NDM-1 and OXA48 genes were the most common encounter (41%), followed by OXA-48 (35%), NDM-1 (12%) and KPC (6%). All isolates were resistant to all generations of cephalosporin and carbapenem. The rate of resistance to tigecycline, polymyxin B and colistin were quite high; 46% (5 from 12 isolates), 17% (2/12) and 17% (3/17) respectively. The prevalence of CRE in this institution was relatively low. However, there is a high prevalence of OXA-48 and NDM co-producer amongst CRE isolates. Physicians should have high index of CRE suspicion in hematological patients.
自1996年首次发现以来，耐碳青霉烯类肠杆菌科细菌（CRE）作为感染病因的报告日益增多，尤其是在免疫功能低下的患者中。由于治疗选择有限，这些多重耐药菌与高死亡率相关，现已被公认为医疗保健相关感染的重要病因。本研究旨在确定马来西亚雪兰莪一家拥有500张床位的三级医院中CRE的流行情况。本研究对2015年1月至2016年12月期间的CRE培养结果进行了鉴定和分析。分离株通过传统方法和Vitek 2®方法进行鉴定。药敏试验采用纸片扩散法进行，并通过E试验进行确认。进行聚合酶链反应以鉴定NDM-1、KPC、OXA-48、VIM和IMP基因。从医院信息系统收集人口统计学数据和临床特征。2015年和2016年CRE的流行率分别为0.3%（5/1590）和1.2%（17/1402）。65%的患者患有潜在血液系统疾病。大多数（81.8%）分离株为肺炎克雷伯菌，其次是粘质沙雷菌、大肠埃希菌和科氏柠檬酸杆菌。同时产生NDM-1和OXA48基因的肺炎克雷伯菌最为常见（41%），其次是OXA-48（35%）、NDM-1（12%）和KPC（6%）。所有分离株对所有代头孢菌素和碳青霉烯类均耐药。对替加环素、多粘菌素B和黏菌素的耐药率相当高；分别为46%（12株中有5株）、17%（2/12）和17%（3/17）。该机构中CRE的流行率相对较低。然而，在CRE分离株中，OXA-48和NDM共同产生菌的流行率较高。医生对血液系统疾病患者应高度怀疑CRE感染。
