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.
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近年来,耐碳青霉烯肠杆菌目(carbapenem-resistant Enterobacteriaceae, CRE)细菌引起的感染日益增多,如未能及时有效治疗,患者预后往往较差,已成为全球面临的公共卫生问题[1-3]。CRE菌株的菌种分布和耐药表型等流行病学特征具有显著的地区特异性[2],本地区分离菌株的流行病学数据对CRE相关感染的防控和治疗尤其重要。因此,本研究拟分析2021年某院CRE菌株的检出情况、体外药物敏感性和碳青霉烯酶型别,现将研究结果报道如下。
1. 材料与方法
1.1 样本来源
2021年四川大学华西医院收治患者的样本(血液、尿液、呼吸道样本等),按照细菌学检验标准操作规程进行样本采集。本研究经四川大学华西医院生物医学伦理审查委员会批准(2020年审954号)。
1.2 质控菌株
大肠埃希菌ATCC25922、ATCC35218,肺炎克雷伯菌ATCC700603,阴沟/霍氏肠杆菌ATCC700323,铜绿假单胞菌ATCC27853,嗜麦芽窄食单胞菌ATCC17666,均为该院临床微生物室保存菌株。
1.3 仪器与试剂
VITEK2-Compact全自动微生物鉴定和药敏分析仪(法国梅里埃),基质辅助激光解吸电离飞行时间质谱仪(德国布鲁克)等仪器。
K-B法药敏纸片(美国赛默飞),多黏菌素B和替加环素的肉汤稀释法药敏试剂条(温州康泰),3-氨基苯硼酸(上海麦克林),乙二胺四乙酸(北京索莱宝)等试剂。
1.4 方法
1.4.1 菌株分离和鉴定
将临床样本按细菌学检验标准操作规程进行检测,35℃、CO2孵箱培养18~24 h,分离纯化可疑菌落,采用基质辅助解析电离飞行时间质谱仪或VITEK2-Compact全自动微生物鉴定和药敏分析仪进行菌种鉴定。
1.4.2 体外药物敏感性试验
采用全自动微生物鉴定和药敏仪和K-B纸片法对肠杆菌目细菌分离株进行常见抗菌药物敏感性试验。采用肉汤稀释法测试菌株对替加环素和多黏菌素B的体外敏感性。
药敏试验结果解释:多黏菌素和替加环素的药敏方法和判断标准采用《多黏菌素类与替加环素及头孢他啶/阿维巴坦药敏方法和报告专家共识》[4];其他药物参照CLSI M100-S31[5]。CRE定义为对亚胺培南、美罗培南、厄他培南或多尼培南任一种药物耐药的肠杆菌目菌株[6]。
1.4.3 碳青霉烯酶型别检测
采用3-氨基苯硼酸联合乙二胺四乙酸(PBA-EDTA)碳青霉烯酶抑制增强试验检测CRE菌株产生的碳青霉烯酶型别[7]。
1.4.4 统计学方法
采用WHONET5.6软件进行CRE菌株来源和对抗菌药物的体外敏感性分析。不同菌种耐药率的比较采用SPSS 20.0软件进行卡方检验和Fisher确切概率法检验,P<0.05为差异有统计学意义。
2. 结果
2.1 临床样本中肠杆菌目细菌的检出情况
2021年,该院从157196份临床样本中分离到肠杆菌目细菌12916株,检出率为8.2%(12916/157196);分离到CRE菌株2215株,检出率为1.4%(2215/157196),其中耐碳青霉烯肺炎克雷伯菌1760株,检出率为1.1% (1760/157196),耐碳青霉烯类阴沟肠杆菌200株,检出率为0.1%(200/157196)。
CRE菌株总数占肠杆菌目细菌分离株总数的17.1%(2215/12916),无菌体液、呼吸道样本、分泌物和血液样本分离到的肠杆菌目细菌中CRE菌株占比较高(18.2%~24.8%),具体见表1。
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 2021Sample 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). 剔除同一患者相同部位的重复菌株后CRE菌株为1134株,这些菌株主要来源为呼吸道标本(494/1134,43.6%)、分泌物(191/1134, 16.8%)和血液(173/1134, 15.3%)。
2.2 患者不同部位样本中CRE菌株的检出情况
1134株CRE非重复菌株分离于903例患者,性别比为3∶1(男∶女),年龄中位数为57.0岁(2月~100岁)。其中,736例(占81.3%)单一部位的样本中检出CRE菌株,从多个部位样本中分离到菌种和耐药表型相同CRE菌株的病例占18.5%(167/903),具体见表2。
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 patientsSample 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 2.3 CRE菌株的菌种分布
从临床样本中分离到的CRE菌株以肺炎克雷伯菌为主(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%)。
各菌种在不同样本中的分离情况见表3,肺炎克雷伯菌和阴沟肠杆菌复合群主要分离于呼吸道标本,分别占46.8%和42.1%;大肠埃希菌及其他肠杆菌目细菌在尿液中检出率较高,分别占34.3%和38.1%。
表 3 CRE菌株的菌种分布Table 3. Species distribution of the CRE strainsSample 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). 2.4 CRE菌株对抗菌药物的体外敏感性
1134株CRE菌株对氨苄西林、氨苄西林/舒巴坦、哌拉西林/舒巴坦、阿莫西林/克拉维酸、头孢唑林、头孢呋辛、头孢曲松、头孢噻肟和厄他培南的耐药率为100%。除替加环素和多黏菌素外,不同菌种对抗菌药物的耐药率差异有统计学意义(P<0.05),具体见表4。
表 4 CRE菌株对抗菌药物的耐药率Table 4. Antibiotic resistance rate of the CRE strainsAntibacterial 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 2.5 CRE菌株的碳青霉烯酶型别
对979株CRE菌株进行碳青霉烯酶型别检测结果图例见图1,其中左图为丝氨酸碳青霉烯酶阳性,检出该类菌株809株(占82.6%);中图为金属β内酰胺酶阳性,检出该类菌株168株(占17.2%);右图为丝氨酸碳青霉烯酶和金属β内酰胺酶均阳性,检出该类菌株2株(占0.2%)。
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 strainsLeft: 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 3-aminobenzeneboronic acid (PBA, 30 g/L); C: imipenem with 10 μL ethylenediamine tetraacetic acid (EDTA, 0.1 mol/L); D: imipenemwith 10 μL EDTA (0.1 mol/L) and 10 μL PBA (30 g/L).从不同种类菌株的检测结果看:肺炎克雷伯菌主要以产丝氨酸碳青霉烯酶为主,占93.3%(768/823);阴沟肠杆菌复合群、大肠埃希菌和其他肠杆菌目细菌以产金属β内酰胺酶为主,分别占88.0%(44/50)、82.6%(57/69)和66.7%(10/15),具体见表5。
表 5 CRE菌株的碳青霉烯酶检出情况Table 5. Carbapenemases detected in the CRE strainsCarbapenemase 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) 3. 讨论
近年来,临床样本中分离到的CRE菌株日益增多,已成为全球关注的公共卫生问题[1-3, 8-9]。不同国家和地区CRE菌株的分离情况不同,2020年中国细菌耐药监测网(CHINET)报道克雷伯菌属分离株对碳青霉烯类药物的耐药率为17.4%~22.4%,其他细菌对碳青霉烯类药物的耐药率大多在12.0%以下[8];非洲东部、地中海东部和东南亚地区CRE菌株在肠杆菌目分离株中的占比分别可达35.0%[10]、68.9%[11]和10.0%[12]。本研究结果显示:2021年该院临床样本中CRE菌株的检出率为1.4%,其中耐碳青霉烯肺炎克雷伯菌占绝大多数(检出率为1.1%);CRE在肠杆菌目细菌分离株的占比为17.1%。提示不同地区分离到的肠杆菌目菌株对碳青霉烯类药物的敏感性存在差异,可能与环境压力和细菌耐药机制等有关,掌握本地区CRE分离株的流行病学特征对于感染治疗和防控具有重要意义。
本研究还发现不同样本中CRE菌株的检出情况也不同,例如:分泌物和呼吸道样本中的CRE检出率较高(分别为2.5%和2.3%),分别占肠杆菌目细菌分离株的18.2%和19.9%;血液和非血液以外的无菌体液样本中CRE检出率较低(分别为0.7%和1.3%),但CRE菌株的占比相对较高(分别为19.8%和24.8%),尤其是脑脊液样本中CRE菌株的占比高达55.4%。提示在细菌耐药监测工作中,分别统计分析不同样本中的CRE检出率更能准确反映CRE菌株的地区流行病学特点;另一方面,在抗感染早期经验治疗时,要结合患者感染部位考虑经验治疗方案。
该院CRE菌株的样本来源主要为呼吸道样本、分泌物和血液,占比分别为43.6%、16.8%和15.3%,提示需重点关注有呼吸道基础疾病、创伤史和血流感染高危因素的患者,采取有效的防控措施,降低CRE相关感染风险。另外,该院CRE菌株主要分离于老年男性,有研究指出老年人群中CRE的检出率增高与其免疫力功能下降、基础疾病和疾病病程相关[13-15]。值得关注的是,本研究发现18.5%的患者从多个部位的样本中分离出相同CRE菌株,提示CRE菌株可能在机体多个部位播散,这与患者预后是否存在关系有待于进一步研究。
从全球细菌耐药监测情况看,肺炎克雷伯菌是肠杆菌目细菌中耐药形势最为严峻的菌种[16]。该院CRE菌株中肺炎克雷伯菌占比最高(占77.9%),其次是阴沟肠杆菌复合群(占9.4%)和大肠埃烯菌(占8.5%),提示需特别关注耐碳青霉烯类肺炎克雷伯菌在本地区引起感染的危险因素。
对该院CRE菌株的体外敏感性分析结果显示,CRE菌株对多种常见抗菌药物的耐药率高于90.0%,这与CHINET报道的结果相似[8],但对多黏菌素B和替加环素的耐药率较低(分别为3.2%和1.9%)。并且,除多黏菌素B和替加环素外,不同菌种的CRE菌株对抗菌药物的耐药率差异具有统计学意义(P<0.05)。提示在CRE相关感染的治疗过程中,应根据分离株的菌种鉴定和体外药敏结果及时调整治疗方案。
产生碳青霉烯酶是肠杆菌目细菌对碳青霉烯类药物的主要耐药机制[17]。碳青霉烯酶的型别检测结果可指导临床用药,因不同种类的酶抑制复合制剂对产不同型别碳青霉烯酶CRE菌株的抑制能力不同,例如:头孢他啶/阿维巴坦对产丝氨酸碳青霉烯酶菌株具有抑菌活性,但对产金属β内酰胺酶菌株无抑菌活性。另外,有研究指出,对于产金属β内酰胺酶,联合用药(如:头孢他啶/阿维巴坦联合氨曲南)可增强药物对菌株的抑菌活性[18-19]。
目前,检测CRE菌株中碳青霉烯酶型别的方法主要有表型检测法和基因型检测法[7]。PBA-EDTA碳青霉烯酶抑制剂增强试验为一种表型检测法,可同时筛查丝氨酸碳青霉烯酶和金属β内酰胺酶,操作简便,易于在基层实验室开展。本研究发现,该院耐碳青霉烯肺炎克雷伯菌以产丝氨酸碳青霉烯酶菌株为绝大部分,占93.3%;耐碳青霉烯大肠埃希菌、阴沟肠杆菌复合群及其他肠杆菌目细菌以产金属β内酰胺酶菌株为主,分别占82.6%、88.0%和66.7%。与国内外其他地区相比[20-22],本地区CRE菌株的酶型分布不同,其分子机制有待于后续深入研究。
综上所述,该院临床样本中的CRE菌株以产丝氨酸碳青霉烯酶肺炎克雷伯菌为主,菌株的体外敏感性和碳青霉烯酶型别检测对于指导合理选择治疗药物具有重要意义。另外,本研究仅从实验室角度关注了CRE的流行病学特征,后续可以进一步分析CRE引起呼吸道、伤口和血液系统等部位感染的危险因素。
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利益冲突 所有作者均声明不存在利益冲突
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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 3-aminobenzeneboronic acid (PBA, 30 g/L); C: imipenem with 10 μL ethylenediamine tetraacetic acid (EDTA, 0.1 mol/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). 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 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). 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 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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