Li Yiwen, Mai Ying, Liu Yingxin, Jiang Yueting
Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, Guangdong, People's Republic of China.
Infect Drug Resist. 2025 Apr 25;18:2105-2117. doi: 10.2147/IDR.S507692. eCollection 2025.
In this study, carbapenem-resistant Enterobacterales (CRE) were isolated from a teaching hospital in Guangzhou between January 2020 and March 2023, meticulously examining the antimicrobial resistance patterns, carbapenemase types, and epidemiological characteristics of these isolated strains. This comprehensive analysis serves as an invaluable insight for optimizing CRE treatment strategies for clinical practitioners and implementing robust measures to prevent and control nosocomial infections within healthcare settings.
The antimicrobial susceptibility testing aimed to ascertain carbapenem resistance in Enterobacterales, while the production of carbapenemase was assessed through rapid phenotypic identification by immunochromatographic assay (KPC, NDM, VIM, IMP, and OXA-48-like) and confirmed by PCR.
Among the 300 CRE strains collected from January 2020 to March 2023, (CR-Kpn) accounted for 72.7%, (CR-Eco) 12.3%, (CR-Ecl) 8.3%, (CR-Eae) 2.3%, (CR-Cfr) 2.0%, and others 2.3%. Among the five carbapenemase types, KPC-like ranked first accounting for 66.7%, followed by NDM-like (23.0%), OXA-48-like (0.7%), and IMP-like (0.7%), of which six strains of KPC-like plus NDM-like were detected simultaneously. Although KPC-like predominated in adults and the elderly, NDM-like was more common in children. These CRE strains showed high resistance to most antibiotics; however, they showed high sensitivity to tigecycline and colistin.
CRE strains exhibited a high resistance rate of multiple antibacterial drugs, and KPC-like were widely prevalent in CRE strains, particularly . Clinical attention should be paid to the rational use of antibacterial drugs, and CRE monitoring and hospital infection prevention and control should be continuously strengthened.
本研究于2020年1月至2023年3月期间，从广州一家教学医院分离出耐碳青霉烯类肠杆菌科细菌（CRE），细致研究了这些分离菌株的耐药模式、碳青霉烯酶类型及流行病学特征。这一全面分析为临床医生优化CRE治疗策略以及在医疗机构内实施强有力的医院感染预防与控制措施提供了宝贵见解。
抗菌药物敏感性试验旨在确定肠杆菌科细菌对碳青霉烯类的耐药性，而碳青霉烯酶的产生通过免疫层析法（KPC、NDM、VIM、IMP和OXA-48样）进行快速表型鉴定评估，并通过PCR进行确认。
在2020年1月至2023年3月收集的300株CRE菌株中，肺炎克雷伯菌（CR-Kpn）占72.7%，大肠埃希菌（CR-Eco）占12.3%，阴沟肠杆菌（CR-Ecl）占8.3%，产酸克雷伯菌（CR-Eae）占2.3%，弗劳地枸橼酸杆菌（CR-Cfr）占2.0%，其他占2.3%。在五种碳青霉烯酶类型中，KPC样占首位，为66.7%，其次是NDM样（23.0%）、OXA-48样（0.7%）和IMP样（0.7%），其中同时检测到6株KPC样加NDM样。虽然KPC样在成人和老年人中占主导，但NDM样在儿童中更常见。这些CRE菌株对大多数抗生素表现出高耐药性；然而，它们对替加环素和黏菌素表现出高敏感性。
CRE菌株呈现多种抗菌药物的高耐药率，且KPC样在CRE菌株中广泛流行，尤其是肺炎克雷伯菌。应重视抗菌药物的合理使用，并持续加强CRE监测及医院感染防控。
