2016—2018年某医院CRE临床分布、耐药性及碳青霉烯酶基因检测

目的 了解耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae, CRE)的临床分布、耐药性及碳青霉烯酶基因型，为临床抗感染治疗及医院感染防控提供依据。方法 收集2016年1月至2018年12月蚌埠医学院第一附属医院临床分离的CRE菌株，采用VITEK 2 Compact全自动细菌鉴定药敏分析仪进行药敏实验。药敏结果判读参照CLSI 2018版标准，WHONET 5.6软件统计分析。PCR方法检测常见碳青霉烯酶基因。结果 2016年1月至2018年12月我院临床标本中共分离出626株CRE，总检出率为12.46%。其中主要为肺炎克雷伯菌和大肠埃希菌，分别占84.35%(528/626)和9.27%(58/626)。标本来源主要为痰56.87%(356/626)、尿液12.14%(76/626)、血液10.38%(65/626)。病区分布主要为急诊内科32.75%(205/626)和重症监护病房25.08%(157/626)。626株CRE菌株对甲氧苄啶-磺胺甲噁唑和阿米卡星耐药率分别为56.07%和69.65%，其余在测试的抗菌药物耐药率均高于80%。626株CRE中602株检出携带常见碳青霉烯酶基因。602株菌主要包括肺炎克雷伯菌515株(510株携带blaKPC-2基因，5株携带blaNDM-1基因，2株携带blaIPM基因)；大肠埃希菌54株(43株携带blaKPC-2基因，13株携带blaNDM-1基因，1株携带blaIPM基因)。其中3株大肠埃希菌和2株肺炎克雷伯菌同时检出blaKPC-2基因和blaNDM-1基因。未检出blaVIM和blaOXA-48基因。结论

Analysis of clinical distribution,drug resistance,and carbapenemase gene detection of CRE in a hospital from 2016 to 2018

Objective To investigate the clinical distribution, drug susceptibility, and carbapenemase genotypes of carbapenem-resistant Enterobacteriaceae (CRE), which provides the evidence for clinical antibiotic therapy and nosocomial infection control. Methods CRE strains were collected from the First Affiliated Hospital of Bengbu Medical College from January 2016 to December 2018 and analyzed for antimicrobial susceptibility by VITEK 2 Compact systems according to the CLSI 2018 standard. Carbapenemase genes were detected by PCR. Statistic analysis was performed using WHONET 5.6 software. Results A total of 626 CRE strains were isolated from clinical specimens, and the total detection rate was 12.46%. Klebsiella pneumoniae (84.35%, 528/626) and Escherichia coli (9.27%, 58/626) were the major strains. Of the 626 isolates, 56.87% (356/626), 12.14% (76/626), and 10.38% (65/626) were from sputum, urine, and blood, respectively. 32.75% (205/626) and 25.08% (157/626) were from the emergency department and the intensive care unit. The antimicrobial susceptibility test showed that the resistance rates of 626 CRE strains to most antibiotic were more than 80% except trimethoprim-sulfamethoxazole (56.07%) and amikacin (69.65%). Of the 626 CRE strains 602 strains carried carbapenemase genes, among the 602 strains, the blaKPC-2 gene was detected from 510 Klebsiella pneumoniae strains and 43 Escherichia coli strains, the blaNDM-1 gene from five strains of Klebsiella pneumoniae and 13 strains of Escherichia coli, and the IPM gene from two strains of Klebsiella pneumoniae and one strain of Escherichia coli . Both of the blaKPC-2 gene and the blaNDM-1 gene were detected in three strains of Escherichia coli and two strains of Klebsiella pneumoniae. blaVIM and blaOXA-48 genes were not detected. Conclusion The resistance rate of CRE strains was very high. The main carbapenemase gene was blaKPC-2 and strict infection control measures should be put in place to prevent the spread of nosocomial infections.