目的 明确2024年珠海市中西医结合医院住院患者中多重耐药肠杆菌科细菌（重点为肺炎克雷伯菌、大肠埃希菌）的感染流行特征、耐药基因分布及感染危险因素,为临床针对性防控提供数据支持。方法 回顾性收集2024年本院临床分离的116例多重耐药肠杆菌科细菌感染住院患者病例,其中耐碳青霉烯类肠杆菌科细菌（CR-E）41株、产超广谱β-内酰胺酶（ESBL）肠杆菌科细菌75株。采用VITEK MS系统鉴定细菌种属,VITEK 2 Compact系统或K-B法进行药敏试验,双纸片协同试验检测ESBL,改良Hodge试验与金属酶筛选试验确认碳青霉烯酶表型,PCR扩增检测耐药基因（CR-E菌株检测KPC、NDM、VIM型;产ESBL菌检测TEM、CTX-M、SHV型）,多元Logistic回归分析感染危险因素。结果 116例感染病例中,CR-E以肺炎克雷伯菌（48.78%,20/41）和大肠埃希菌（31.71%,13/41）为主,对亚胺培南、美罗培南耐药率分别为80.49%（33/41）、78.05%（32/41）;产ESBL菌以大肠埃希菌（72.00%,54/75）和肺炎克雷伯菌（20.00%,15/75）为主。CR-E中KPC型耐药基因检出率最高（51.22%,21/41）,其次为NDM型（34.15%,14/41）;产ESBL菌中TEM型检出率最高（62.67%,47/75）,其次为CTX-M型（48.00%,36/75）。多元Logistic回归显示,入住重症监护室（OR=3.49,95% CI：1.75~6.95,P<0.001）、既往抗菌药物使用（OR=2.41,95% CI：1.39~4.16,P=0.002）、侵入性操作（OR=2.77,95% CI：1.48~5.19,P=0.001）是感染的独立危险因素。结论 2024年本院住院患者多重耐药肠杆菌科细菌感染以耐碳青霉烯类肺炎克雷伯菌、产ESBL大肠埃希菌为主,KPC、TEM型分别为两类细菌的主要耐药基因;入住重症监护室、既往抗菌药物使用、侵入性操作为关键危险因素,临床需针对性加强防控措施。
Abstract
Objective To clarify the epidemiological characteristics, distribution of drug-resistant genes, and risk factors of multidrug-resistant Enterobacteriaceae (with a focus on Klebsiella pneumoniae and Escherichia coli) infections in inpatients at Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine in 2024, and to provide data support for targeted clinical prevention and control. Methods A retrospective analysis was conducted on 116 cases of inpatients with multidrug-resistant Enterobacteriaceae infections in our hospital in 2024, from whom multidrug-resistant Enterobacteriaceae strains were clinically isolated. Among these strains, there were 41 carbapenem-resistant Enterobacteriaceae (CR-E) strains and 75 extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae strains. The VITEK MS system was used for bacterial species identification, while the VITEK 2 Compact system or Kirby-Bauer (K-B) method was applied for drug susceptibility testing. ESBL was detected via the double-disk synergy test. The modified Hodge test and metalloenzyme screening test were used to confirm the carbapenemase phenotype. Polymerase chain reaction (PCR) amplification was performed to detect drug-resistant genes (KPC, NDM, and VIM types for CR-E; TEM, CTX-M, and SHV types for ESBL-producing bacteria). Multivariate Logistic regression analysis was used to identify the risk factors for infection. Results Among the 116 infection cases, CR-E was mainly composed of Klebsiella pneumoniae (48.78%, 20/41) and Escherichia coli (31.71%, 13/41), with resistance rates of 80.49% (33/41) to imipenem and 78.05% (32/41) to meropenem. ESBL-producing bacteria were predominantly Escherichia coli (72.00%, 54/75) and Klebsiella pneumoniae (20.00%, 15/75). For CR-E, the detection rate of KPC-type drug-resistant genes was the highest (51.22%, 21/41), followed by NDM-type (34.15%, 14/41). For ESBL-producing bacteria, the detection rate of TEM-type drug-resistant genes was the highest (62.67%, 47/75), followed by CTX-M-type (48.00%, 36/75). Multivariate Logistic regression analysis showed that admission to the intensive care unit (ICU) (OR=3.49, 95% CI: 1.75-6.95, P<0.001), previous use of antibacterial agents (OR=2.41, 95% CI: 1.39-4.16, P=0.002), and invasive procedures (OR=2.77, 95% CI: 1.48-5.19, P=0.001) were independent risk factors for infection. Conclusion In 2024, multidrug-resistant Enterobacteriaceae infections in inpatients at our hospital were mainly caused by carbapenem-resistant Klebsiella pneumoniae and ESBL-producing Escherichia coli. KPC-type and TEM-type genes were the main drug-resistant genes in these two types of bacteria, respectively. Admission to the ICU, previous use of antibacterial agents, and invasive procedures were key risk factors. Targeted measures should be strengthened for clinical prevention and control.
关键词
多重耐药肠杆菌科细菌 /
肺炎克雷伯菌 /
大肠埃希菌 /
耐药基因 /
细菌感染
Key words
multidrug-resistant enterobacteriaceae /
Klebsiella pneumoniae /
Escherichia coli /
drug-resistant genes /
bacterial infection
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基金
广东省中医药局科研项目“基于‘虚证’理论的益气活血化痰方治疗老年坠积性肺炎的临床疗效与安全性研究”（202405132318019550）
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