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Epidemiological Analysis of Carbapenem-Resistant Enterobacteriaceae Strains in the Clinical Specimens of a Hospital
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摘要:
目的 分析某院临床样本中耐碳青霉烯肠杆菌目（carbapenem-resistant Enterobacteriaceae, CRE）菌株的检出率、对抗菌药物的体外敏感性和碳青霉烯酶型别，为CRE相关感染的防控和治疗提供依据。 方法 按照细菌学检验操作规程进行临床样本检测，对分离菌株进行菌种鉴定和体外药敏试验。对CRE菌株采用3-氨基苯硼酸联合乙二胺四乙酸碳青霉烯酶抑制剂增强试验检测的碳青霉烯酶型别。 结果 2021年该院从157196份临床样本中分离到CRE菌株2215株，检出率为1.4%（2215/157196）。1134株CRE非重复株分离于903例患者，主要样本来源为呼吸道样本（494/1134，43.6%）、分泌物（191/1134，16.8%）和血液（173/1134，15.3%），从同一患者的二个、三个和四个部位的样本中分离出相同CRE菌株的病例分别占12.5%、4.9%和1.1%。CRE最常见菌种是肺炎克雷伯菌（883/1134，77.9%），其次是阴沟肠杆菌复合群（107/1134，9.4%）和大肠埃希菌（96/1134，8.5%）。不同菌种对多黏菌素B和替加环素的耐药率差异无统计学意义（P<0.05）。产丝氨酸碳青霉烯酶、产金属β内酰胺酶以及同时产生两种酶的菌株分别占82.6%（809/979）、17.2%（168/979）和0.2%（2/979）。 结论 CRE菌株主要分离于呼吸道样本、分泌物和血液。产丝氨酸碳青霉烯酶肺炎克雷伯菌最为常见，对多种抗菌药物的耐药率高，应关注该类细菌相关感染的危险因素。 Abstract:Objective To analyze the detection rate, in vitro susceptibility to antibiotics, and carbapenemase types of carbapenem-resistant Enterobacteriaceae (CRE) strains in the clinical samples of a hospital and to provide support for the prevention, control and treatment of CRE-related infections. Methods Clinical specimens were examined according to the operating procedures of bacteriological tests. Species identification and in vitro drug susceptibility testing were performed on the isolated strains. Carbapenemase inhibitor enhancement testing, which combined the use of 3-aminobenzeneboronic acid and ethylenediaminetetraacetic acid, was conducted to identify the types of carbapenemase in the CRE strains. Results In 2021, 2215 CRE strains were isolated from 157196 clinical samples collected in this hospital, presenting a detection rate of 1.4% (2215/157196). A total of 1134 non-repetitive strains of CRE were isolated from 903 patients. The main sources of samples were respiratory tract (494/1134, 43.6%), secretion (191/1134, 16.8%) and blood (173/1134, 15.3%) samples. The cases with the same CRE strain isolated from the samples of two, three and four sites accounted for 12.5%, 4.9%, and 1.1%, respectively. The most common species was Klebsiella pneumoniae (883/1134, 77.9%), followed by Enterobacter cloacae complex (107/1134, 9.4%) and Escherichia coli (96/1134, 8.5%). The rates of resistance to polymyxin B and tigecycline of different species of CRE strains were not significantly different (P<0.05). Serine carbapenemase-producing strains, metallo-β-lactamase-producing strains, and those producing both enzymes accounted for 82.6% (809/979), 17.2% (168/979), and 0.2% (2/979), respectively. Conclusion CRE strains are frequently isolated from samples collected from the respiratory tract, secretion, and blood. The most common strain is serine carbapenemase-producing K. pneumoniae, which has a high resistance rate to various antimicrobial drugs, and risk factors of its associated infections deserve more attention. -
Key words:
- Carbapenem-resistant Enterobacteriaceae /
- Resistance rate /
- Carbapenemase
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图 1 CRE菌株碳青霉烯酶检测结果示例
Figure 1. Examples of carbapenemase examination result for the CRE strains
Left: serine carbapenemase positive sample; middle: metal β-lactamase positive sample; right: serine carbapenemase positive and metal β- lactamase positive sample. A: imipenem (10 μg/disk); B: imipenem with 10 μL ethylenediamine tetraacetic acid (EDTA, 0.1 mol/L); C: imipenem with 10 μL 3-aminobenzeneboronic acid (PBA, 30 g/L); D: imipenemwith 10 μL EDTA (0.1 mol/L) and 10 μL PBA (30 g/L).
表 1 2021年临床样本中肠杆菌目细菌的检出情况
Table 1. Enterobacteriaceae isolated from clinical specimens in 2021
Sample type Number of
samplesStrains of
Enterobacteriaceae
detectedDetection
rate of
Enterobacteriaceae/%Strains of
CRE detectedDetection rate
of CRE/%The ratio of CRE in
Enterobacteriaceae/%Respiratory tract samples 41751 4807 11.5 958 2.3 19.9 Secretion 14454 2021 14.0 368 2.5 18.2 Blood 70447 2444 3.5 484 0.7 19.8 Urine 15539 2853 18.4 209 1.3 7.3 Aseptic fluid 15005 791 5.3 196 1.3 24.8* * Pleural effusion, 24.0% (12/50); ascites, 27.5% (83/302); cerebrospinal fluid, 55.4% (41/74); puncture fluid, 15.9% (26/164); bile, 20.6% (34/165); joint fluid, 0% (0/36). 
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表 2 患者不同部位样本中CRE菌株的检出情况
Table 2. CRE isolated from samples collected from different sites of the patients
Sample type Single site (n=736) Two sites (n=113) Three sites (n=44) Four sites (n=10) Strains % Strains % Strains % Strains % Respiratory tract samples 380 51.6 83 36.7 29 21.9 5 12.5 Secretion 101 13.7 31 13.7 33 25.0 10 25.0 Blood 82 11.1 48 21.2 34 25.8 9 22.5 Urine 105 14.3 27 12.0 12 9.1 4 10.0 Aseptic fluid 68 9.3 37 16.4 24 18.2 12 30.0
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表 3 CRE菌株的菌种分布
Table 3. Species distribution of the CRE strains
Sample type Klebsiella spp. (n=910) Enterobacter cloacae
complex (n=107)/%Escherichia coli
(n=96)/%Others* (n=21)/% K. pneumoniae (n=883)/% K. oxytoca (n=15)/% K. aerogenes (n=12)/% Respiratory tract sample 46.8 46.7 33.2 42.1 22.9 14.3 Secretion 16.4 13.3 16.7 23.4 12.5 23.8 Blood 16.3 33.3 16.7 8.4 11.5 9.5 Urine 10.3 0.0 16.7 14.0 34.3 38.1 Aseptic fluid 10.2 6.7 16.7 12.1 18.8 14.3 Total 100 100 100 100 100 100 * Citrobacter freundii (11 strains), Raoultella ornithinolytica (4 strains), Providencia spp. (2 strains), Morganella morganella (1 strain)，Proteus mirabilis (2 strains), and Raoultella planticola (1 strain).
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表 4 CRE菌株对抗菌药物的耐药率
Table 4. Antibiotic resistance rate of the CRE strains
Antibacterial agent Klebsiella spp. (n=910)/% Enterobacter
cloacae complex
(n=107)/%Escherichia coli (n=96)/% Others (n=21)/% χ2 P K. pneumoniae
(n=883)K. oxytoca
(n=15)K. aerogenes
(n=12)Ceftazidime 100.0 100.0 100.0 95.3 97.9 100.0 37.8 <0.001 Cefepime 99.2 100.0 83.3 79.4 98.9 90.4 130.4 <0.001 Aztreonam 97.7 100.0 100.0 84.1 88.5 85.7 61.3 <0.001 Imipenem 97.8 93.3 91.6 65.4 79.1 95.2 146.0 <0.001 Meropenem 97.8 93.3 83.3 65.4 79.1 95.2 150.4 <0.001 Gentamicin 72.4 66.6 25.0 35.5 67.9 52.3 59.7 <0.001 Amikacin 68.2 20.0 16.6 17.7 36.4 28.5 126.3 <0.001 Tobramycin 71.4 33.3 25.0 41.4 62.5 52.3 39.1 <0.001 Levofloxacin 97.0 86.6 25.0 68.2 93.7 95.2 114.9 <0.001 Ciprofloxacin 97.0 86.6 33.3 71.9 93.7 95.2 94.3 <0.001 Trimethoprim-Sulfamethoxazole 67.7 66.6 33.3 57.9 81.2 80.9 14.5 0.002 Tetracycline 77.0 46.6 33.3 63.5 90.6 90.4 22.89 <0.001 Minocycline 45.6 33.3 16.6 39.3 38.5 50.0 24.0 <0.001 Tigecycline 1.9 6.6 0.0 1.9 0.0 5.0 2.8 0.412 Polymyxins B 3.6 0.0 0.0 0.0 0.0 0.9 2.6 0.447
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表 5 CRE菌株的碳青霉烯酶检出情况
Table 5. Carbapenemases detected in the CRE strains
Carbapenemase type Klebsiella spp. (n=845) Enterobacter cloacae complex (n=50)/strain (%) Escherichia coli (n=69)/strain (%)
Others (n=15)/
strain (%)K. pneumoniae (n=823)/strain (%) K. oxytoca (n=14)/strain (%) K. aerogenes (n=8)/strain (%) Serine carbapenemase 768 (93.3) 12 (85.7) 6 (75.0) 6 (12.0) 12 (17.4) 5 (33.3) Metal β-lactamase 53 (6.4) 2 (14.3) 2 (25.0) 44 (88.0) 57 (82.6) 10 (66.7) Serine carbapenemaseand metal β-lactamase 2 (0.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
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