河南省某医院耐碳青霉烯类革兰阴性杆菌的临床分布及耐药谱

目的 了解耐碳青霉烯类革兰阴性杆菌（CR-GNB）的临床分布及其耐药特征，为指导临床抗菌药物的合理使用提供依据。方法 收集2017年1月—2018年10月某院临床分离的CR-GNB，使用WHONET 5.6软件进行统计学分析。结果 共收集CR-GNB 9 506株，其中耐碳青霉烯类抗生素鲍曼不动杆菌（CRAB）3 879株（40.18%），耐碳青霉烯类抗生素肺炎克雷伯菌（CRKP）3 602株（37.89%），耐碳青霉烯类抗生素铜绿假单胞菌（CRPA）1 322株（13.91%），耐碳青霉烯类抗生素大肠埃希菌（CREC）334株（3.51%）。CR-GNB主要分布在ICU（6 340株，66.69%），其次是呼吸内科（751株，7.90%）；以呼吸道标本来源的菌株最多（6 614株，69.58%），其次是血标本（800株，8.42%）。四种主要的CR-GNB均对常见抗菌药物普遍耐药，其中CRPA仅对多粘菌素B、阿米卡星较敏感，敏感率分别为99.39%、74.18%；CRAB、CRKP对替加环素、多粘菌素B、米诺环素较为敏感，敏感率为60.30%~99.66%；CREC对替加环素、多粘菌素B、阿米卡星、米诺环素较为敏感，敏感率为66.49%~99.13%。结论 CR-GNB耐药情况严重，特别是ICU分离株，临床医生应个体化制定更为合理的抗感染治疗方案，加强感染控制措施的落实，减少包括CR-GNB在内的多重耐药菌的产生，并控制其在医院内的传播。

Clinical distribution and drug resistance of carbapenem-resistant Gram-negative bacillus in a hospital of Henan Province

Objective To understand clinical distribution and drug resistance characteristics of carbapenem-resis-tant Gram-negative bacillus (CR-GNB), and provide basis for guiding clinical rational use of antimicrobial agents. Methods Clinical isolates of CR-GNB were collected from a hospital between January 2017 and October 2018, statistical analysis was performed by WHONET 5.6 software. Results A total of 9 506 strains of CR-GNB were collected, including 3 879 strains (40.18%) of carbapenem-resistant Acinetobacter baumannii (CRAB), 3 602 strains (37.89%) of carbapenem-resistant Klebsiella pneumoniae (CRKP), 1 322 (13.91%) strains of carbapenem-resis-tant Pseudomonas aeruginosa (CRPA) and 334 strains (3.51%) of carbapenem-resistant Escherichia coli (CREC). CR-GNB mainly distributed in intensive care unit (ICU) (6 340 strains, 66.69%), followed by department of respiratory medicine (751 strains, 7.90%); most strains were isolated from respiratory specimens (6 614 strains, 69.58%), followed by blood specimens (800 strains, 8.42%). Four major CR-GNB were generally resistant to common antimicrobial agents, CRPA was only susceptible to polymyxin B and amikacin, with susceptibility rates of 99.39% and 74.18% respectively; CRAB and CRKP were susceptible to tigecyclin, polymyxin B and minocycline, with susceptibility rates of 60.30%-99.66%; CREC was susceptible to tegacyclin, polymyxin B, amikacin and minocycline, with susceptibility rates of 66.49%-99.13%. Conclusion Antimicrobial resistance of CR-GNB is serious, especially in strains from ICU, clinicians should make more rational anti-infective treatment scheme and strengthen the implementation of infection control measures, reduce the emergence of multidrug-resistant organism and control the spread in hospital.