2010—2016年耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分布及其耐药特征

目的了解临床分离的耐碳青霉烯类肺炎克雷伯菌（CRKP）及耐碳青霉烯类大肠埃希菌（CREC）的临床分布状况及耐药特征。方法回顾性分析某院2010年1月-2016年12月临床标本分离的肺炎克雷伯菌及大肠埃希菌，统计分析CRKP及CREC分离情况。结果2010-2016年7年共收集临床分离耐碳青霉烯类肠杆菌科细菌（CRE）310株（CRKP 268株，CREC 42株），CRKP检出率由2010年的1.33%上升到2016年的12.70%，呈逐年上升趋势（χ2=123.73，P＜0.01）；CREC检出率则处于相对稳定状态，2010-2016年均约为1.00%；标本来源和病区分布最多者分别为呼吸道标本（45.49％）和重症监护病房（31.93％）。药敏试验结果显示，CRKP和CREC除对阿米卡星耐药率稍低（分别为 80.60%、 38.10%）外，对大多数临床常用抗菌药物如第三代头孢菌素类、第四代头孢菌素类、β 内酰胺类/酶抑制剂类、喹诺酮类等耐药率CRKP均＞90%、CREC均在80%左右，而非CRE菌株的耐药率低于CRE菌株（P<0.01）。结论7年间临床分离的CRKP的检出率呈现快速增加的趋势，几乎对常用抗菌药物均耐药，应予以高度关注。

Distribution and antimicrobial resistance of carbapenem resistant Klebsiella pneumoniae and Escherichia coli in 2010-2016

ObjectiveTo understand the clinical distribution and antimicrobial resistance characteristics of clinica lly isolated carbapenem resistant Klebsiella pneumoniae (CRKP) and carbapenem resistant Escherichia coli （CREC）. MethodsClinically isolated Klebsiella pneumoniae and Escherichia coli from a hospital between January 2010 and December 2016 were analyzed retrospectively, isolation of CRKP and CREC were conducted statistical analysis. ResultsFrom 2010 to 2016, a total of 310 carbapenem resistant Enterobacteriaceae (CRE) isolates (268 were CRKP strains and 42 were CREC strains) were collected, isolation rate of CRKP increased from 1.33% in 2010 to 12.70% in 2016, showing an increasing trend year by year (χ2=123.73, P< 0.01); isolation rate of CREC was relatively stable, were all about 1.00% from 2010 to 2016. Most specimens were respiratory tract specimens (45.49%) and from intensive care unit (31.93%). Antimicrobial susceptibility testing showed that except resistance rates of CRKP and CREC were slightly lower to amikacin (80.60% and 38.10% respectively), resistance rates of CRKP to most commonly used antimicrobial agents, such as third generation cephalosporins, fourth generation cephalosporins, β lactamase/lactamase inhibitors, and quinolones were all＞90%, resistance rates of CREC to above antimicrobial agents were all about 80%, resistance rate of non CRE strains was lower than that of CRE strains (P<0.01). ConclusionDuring the past 7 years, detection rate of clinically isolated CRKP increased rapidly, were almost resistant to commonly used antimicrobial agents, which should be paid close attention.