河北以岭医院6种重点监测耐药菌的分布特点及耐药分析

目的 分析河北以岭医院2018—2020年6种重点监测耐药菌的分布特点及耐药性,为临床控制感染及规范用药提供理论依据。方法 回顾性分析2018—2020年住院患者分离的6种重要耐药菌,包括耐碳青霉烯类大肠埃希菌（CREC）、耐碳青霉烯类肺炎克雷伯菌（CRKP）、耐碳青霉烯类铜绿假单胞菌 （CRPAE）、耐碳青霉烯类鲍曼不动杆菌（CRAB）、耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）的分布情况及耐药特点;并采用改良碳青霉烯灭活（mCIM）试验和EDTA改良碳青霉烯灭活（eCIM）试验进行93株耐碳青霉烯类肠杆菌目细菌（CRE）菌株的酶型检测。结果 连续3年共检出CREC 9株、CRKP 253株、CRAB 252株、CRPAE 227株、MRSA 99株、VRE 9株。主要集中在重症监护室、肺病科、神经外科等科室;主要检出标本类型为呼吸道标本,其次为尿液标本、分泌物标本等。mCIM和eCIM试验结果显示,86株CRKP菌株中,mCIM阳性81株;mCIM和eCIM同时阳性即金属酶阳性菌株15株（17.4%）;mCIM阳性和eCIM阴性即丝氨酸酶阳性菌株66株（76.7%）;7株CREC菌株中mCIM和eCIM全部阳性。结论 临床耐药菌株日益增多,尤其是CRE和CRPAE菌株,使临床抗感染治疗面临严峻的挑战,应积极采取有效防控措施,加强耐药菌感染的预防和控制,提高诊疗能力建设,遏制耐药菌的流行播散。

Distribution characteristics and antibiotic resistance of six important of drug-resistant bacteria in Hebei Yiling Hospital

Objective Six important of drug-resistant bacteria were analysed on distribution characteristics and antibiotic resistance in Hebei Yiling Hospital from 2018 to 2020, which provide evidence whether aright clinical drug choice or antimicrobial-resistant bacteria control strategy will be made. Methods From 2018 to 2020, strains isolated from Hebei Yiling Hospital, including six kinds of important pathogens: carbapenem resistant Escherichia coli (CREC), carbapenem resistant Klebsiella pneumoniae (CRKP), carbapenem resistant Pseudomonas aeruginosa (CRPAE), carbapenem resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), were all analysed for their drug resistance character and resistant rate; The enzyme type of 93 carbapenem resistant Enterobacteriaceae (CRE) strains were determined by modified carbapenem inactivation (mCIM) test and EDTA modified carbapenem inactivation (eCIM) test. Results The total pathogens include 9 strains of CREC, 253 strains of CRKP, 252 strains of CRAB, 227 strains of CRPAE, 99 strains of MRSA and 9 strains of VRE during the three years′ period, isolated mainly from intensive care unit, pulmonary disease department, neurosurgery department. The respiratory tract specimens were the most common , followed by urine specimens and secretion specimens , etc. There were 81 mCIM-positive strains in all 86 CRKP strains. The metalloenzyme positive strains were 15（17.4%） with both mCIM-positive and eCIM-positive. 66 strains （76.7%） were positive for serinase, mCIM-positive and eCIM-negative. mCIM and eCIM were all positive in 7 strains of CREC. Conclusions The clinical drug-resistant strains, especially CRE and CRPAE strains, become more and more popular, threaten the clinical treatment severely. Effective prevention and control measures should be taken to strengthen the prevention and control of drug-resistant bacteria infection. The ability of diagnosis and treatment should be improved. The drug-resistant bacteria should be curbed.