[某医院临床标本中耐碳青霉烯类肠杆菌科菌株的流行病学分析]
[Epidemiological Analysis of Carbapenem-Resistant Enterobacteriaceae Strains in the Clinical Specimens of a Hospital].
作者信息
Yuan Yu, Zhou Dan, Liao Quan-Feng, Tang Si-Shi, He Chao
机构信息
Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 May;54(3):602-607. doi: 10.12182/20230560203.
OBJECTIVE
To analyze the detection rate, susceptibility to antibiotics, and carbapenemase types of carbapenem-resistant Enterobacteriaceae (CRE) strains in the clinical samples of a hospital and to provide support for the prevention, control and treatment of CRE-related infections.
METHODS
Clinical specimens were examined according to the operating procedures of bacteriological tests. Species identification and drug susceptibility testing were performed on the isolated strains. Carbapenemase inhibitor enhancement testing, which combined the use of 3-aminobenzeneboronic acid and ethylenediaminetetraacetic acid, was conducted to identify the types of carbapenemase in the CRE strains.
RESULTS
In 2021, 2215 CRE strains were isolated from 157196 clinical samples collected in this hospital, presenting a detection rate of 1.4% (2215/157196). A total of 1134 non-repetitive strains of CRE were isolated from 903 patients. The main sources of samples were respiratory tract (494/1134, 43.6%), secretion (191/1134, 16.8%) and blood (173/1134, 15.3%) samples. The cases with the same CRE strain isolated from the samples of two, three and four sites accounted for 12.5%, 4.9%, and 1.1%, respectively. The most common species was (883/1134, 77.9%), followed by complex (107/1134, 9.4%) and (96/1134, 8.5%). The rates of resistance to polymyxin B and tigecycline of different species of CRE strains were not significantly different ( <0.05). Serine carbapenemase-producing strains, metallo-β-lactamase-producing strains, and those producing both enzymes accounted for 82.6% (809/979), 17.2% (168/979), and 0.2% (2/979), respectively.
CONCLUSION
CRE strains are frequently isolated from samples collected from the respiratory tract, secretion, and blood. The most common strain is serine carbapenemase-producing , which has a high resistance rate to various antimicrobial drugs, and risk factors of its associated infections deserve more attention.
目的
分析某医院临床标本中耐碳青霉烯类肠杆菌科细菌（CRE）的检出率、抗生素敏感性及碳青霉烯酶类型，为CRE相关感染的预防、控制及治疗提供依据。
方法
按照细菌学检验操作规程对临床标本进行检测。对分离菌株进行菌种鉴定及药敏试验。采用3-氨基苯硼酸和乙二胺四乙酸联合使用的碳青霉烯酶抑制剂增强试验，鉴定CRE菌株中的碳青霉烯酶类型。
结果
2021年，从该医院收集的157196份临床标本中分离出2215株CRE菌株，检出率为1.4%（2215/157196）。从903例患者中分离出1134株非重复的CRE菌株。标本主要来源为呼吸道（494/1134，43.6%）、分泌物（191/1134，16.8%）和血液（173/1134，15.3%）标本。从两个、三个和四个部位标本中分离出相同CRE菌株的病例分别占12.5%、4.9%和1.1%。最常见的菌种是[具体菌种名称1]（883/1134，77.9%），其次是[具体菌种名称2]复合菌（107/1134，9.4%）和[具体菌种名称3]（96/1134，8.5%）。不同种CRE菌株对多粘菌素B和替加环素的耐药率差异无统计学意义（P<0.05）。产丝氨酸碳青霉烯酶菌株、产金属β-内酰胺酶菌株及同时产两种酶的菌株分别占82.6%（809/979）、17.2%（168/979）和0.2%（2/979）。
结论
CRE菌株常见于呼吸道、分泌物及血液标本中。最常见的菌株是产丝氨酸碳青霉烯酶的[具体菌种名称1]，对多种抗菌药物耐药率高，其相关感染的危险因素值得关注。
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