CRE耐药性分析及eCIM联合mCIM的临床应用

doi:10.3969/j.issn.1673-8640.2019.09.007

摘要/Abstract

摘要：

目的了解武汉大学人民医院碳青霉烯类耐药肠杆菌科细菌（CRE）的临床感染特点和耐药性,探讨乙二胺四乙酸-碳青霉烯类失活法（eCIM）联合改良碳青霉烯类失活法（mCIM）的临床应用,为有效防控院内感染和合理使用抗菌药物提供依据。方法分析分离自不同类型临床样本的非重复CRE的药物敏感性试验数据。另随机选取80株亚胺培南和/或美罗培南敏感性降低[最小抑菌浓度（MIC）≥2 μg/mL]的CRE,联合mCIM和eCIM判断其产金属β-内酰胺酶和丝氨酸碳青霉烯酶的情况。结果共检出329株CRE,以肺炎克雷伯菌为主（59.0%）,分布科室广泛,其中重症医学科和神经外科分别占16.4%和16.1% ,感染部位多见于呼吸道（39.2%）。CRE总体对米诺环素和替加环素耐药率较低,分别为25.1%和2.9%,对其他常用抗菌药物的耐药率均高于50.0%。随机选取的80株CRE中有57株产碳青霉烯酶,其中产金属β-内酰胺酶的CRE 28株。结论武汉大学人民医院CRE耐药形势严峻,应随时监测,并根据药物敏感性试验结果合理用药。eCIM联合mCIM检测成本低、操作简单,是一种经济、高效的表型筛选方法。

关键词: 碳青霉烯类耐药肠杆菌科细菌, 耐药性, 金属β-内酰胺酶, 乙二胺四乙酸-碳青霉烯类失活法, 改良碳青霉烯类失活法

Abstract:

Objective To study the clinical infection and drug resistance of carbapenem-resistant Enterobacteriaceae（CRE） in Wuhan University Renmin Hospital,and to investigate the clinical application of ethylenediaminetetraacetic acid-modified carbapenem inactivation method（eCIM） combined with modified carbapenem inactivation method（mCIM） so as to effectively prevent and control infection and provide a reference for reasonable clinical use of antibiotics. Methods The drug susceptibility data of clinical isolates of non-repeatable CRE were analyzed. The mCIM and eCIM were combined to determine whether the 80 isolates produced metallo-beta-lactamase or serine carbapenemase [minimum inhibitory concentration（MIC）≥2 μg/mL]. Results A total of 329 CRE isolates were determined,and they are mainly Klebsiella pneumoniae,accounting for 59.0%. The departments were widely distributed,especially in intensive care unit（ICU） and neurosurgery,accounting for 16.4% and 16.1%,respectively. The infected sites were more common in the respiratory tract,accounting for 39.2%. The drug resistance rates of CRE isolates to the most antibiotics were more than 50.0%,except for minocycline and tigecycline,which were 25.1% and 2.9%,respectively. Totally,57 isolates of producing carbapenemase were determined among the randomly-chosen 80 CRE isolates,of which 28 isolates of metallo-beta-lactamase CRE were produced. Conclusions The drug resistance of CRE is severe in Wuhan University Renmin Hospital,which should be monitored at any time. It should use antibiotics based on drug susceptibility results rationally. The eCIM combined with mCIM is an economical and effective phenotypic detection method.

Key words: Carbapenem-resistant Enterobacteriaceae, Drug resistance, Metallo-beta-lactamase, Ethylenediaminetetraacetic acid-modified carbapenem inactivation method, Modified carbapenem inactivation method

中图分类号:

R446.1

唐克文, 李从荣, 郭静. CRE耐药性分析及eCIM联合mCIM的临床应用[J]. 检验医学, 2019, 34(9): 800-803.

TANG Kewen, LI Congrong, GUO Jing. Drug resistance of CRE and clinical application of eCIM combined with mCIM[J]. Laboratory Medicine, 2019, 34(9): 800-803.

图/表 4

参考文献 14

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菌种类型	菌株数（株）	构成比（%）
肺炎克雷伯菌	194	59.0
大肠埃希菌	43	13.1
阴沟肠杆菌	17	5.2
产气肠杆菌	16	4.9
产酸克雷伯菌	16	4.9
弗劳地柠檬酸杆菌	10	3.0
雷极普罗威登斯菌	7	2.1
奇异变形杆菌	6	1.8
其他	20	6.1
合计	329	100.0

菌种类型	菌株数（株）	构成比（%）
肺炎克雷伯菌	194	59.0
大肠埃希菌	43	13.1
阴沟肠杆菌	17	5.2
产气肠杆菌	16	4.9
产酸克雷伯菌	16	4.9
弗劳地柠檬酸杆菌	10	3.0
雷极普罗威登斯菌	7	2.1
奇异变形杆菌	6	1.8
其他	20	6.1
合计	329	100.0

样本类型	菌株数（株）	构成比(%)
痰	129	39.2
尿液	99	30.1
血液	40	12.2
分泌物	18	5.5
胆汁	12	3.6
胸腹水	12	3.6
脓液	9	2.7
导管尖端	6	1.8
其他	4	1.2
合计	329	100.0

样本类型	菌株数（株）	构成比(%)
痰	129	39.2
尿液	99	30.1
血液	40	12.2
分泌物	18	5.5
胆汁	12	3.6
胸腹水	12	3.6
脓液	9	2.7
导管尖端	6	1.8
其他	4	1.2
合计	329	100.0

抗菌药物	肺炎克雷伯菌	大肠埃希菌	阴沟肠杆菌	总CRE
氨苄西林		100.0		98.7
氨苄西林/舒巴坦	99.5	100.0		96.7
阿莫西林/克拉维酸	99.0	97.6		98.1
头孢唑啉	97.9	100.0		99.4
头孢吡肟	99.5	97.6	94.1	93.0
亚胺培南	99.5	100.0	94.1	98.8
头孢噻肟	99.5	97.6	94.1	95.4
哌拉西林	99.3	100.0	91.7	94.7
哌拉西林/他唑巴坦	99.0	92.9	81.3	92.4
美罗培南	98.5	95.2	100.0	93.3
头孢他啶	97.9	97.6	88.2	93.3
氨曲南	97.4	64.3	64.7	83.3
环丙沙星	95.3	88.1	76.5	84.6
头孢哌酮/舒巴坦	94.3	89.5	100.0	88.3
左氧氟沙星	91.2	88.1	70.6	81.4
庆大霉素	85.0	71.4	76.5	77.1
阿米卡星	75.3	19.0	17.6	53.8
氯霉素	55.6	50.0	60.0	52.5
复方磺胺甲噁唑	53.9	87.8	76.5	59.2
四环素	46.0	88.1	41.2	52.1
米诺环素	21.1	42.1	25.0	25.1
替加环素	2.5	0.0	12.5	2.9