摘要
目的了解杭州市中医院临床各科室分离的耐碳青霉烯肺炎克雷伯菌(CRKP)的检出情况及耐药特点。方法收集2016年—2022年分离自临床样本的非重复CRKP,分析这类菌株的分布特征和耐药性试验结果,采用3-氨基苯硼酸联合乙二胺四乙酸碳青霉烯酶抑制实验检测碳青霉烯酶型,并通过胶体金免疫层析法检测其无法确定酶型的菌株。结果共检测146株CRKP,其中检出最多的是呼吸道标本,检出最多的科室为重症医学科。药敏结果显示,CRKP对β-内酰胺类、碳青霉烯类、氨曲南的耐药率均>95%,对头孢他啶/阿维巴坦的耐药率为2.74%。碳青霉烯酶初筛实验显示产A类丝氨酸酶的菌株共133株,产金属酶2株,不确定菌株11株,酶抑制剂增强试验对酶型的检出率为92.47%。结论本医疗机构CRKP形势严峻,应及时监测。本研究CRKP主要耐药机制为产碳青霉烯酶,并且以产A类丝氨酸酶为主,酶抑制剂增强试验可以检测出大部分酶型,临床实验室应合理优化碳青霉烯酶初筛实验,为临床精准用药提供直接依据。
Objective This paper aims to investigate the detection and antimicrobial resistance characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated from departments of Hangzhou Hospital of Traditional Chinese Medicine.Methods Non-repeated CRKP strains isolated from clinical samples from 2016 to 2022,and the distribution characteristics and antimicrobial resistance test of these strains were analyzed.The carbapenems detection method of 3-aminobenzene boric acid combined with ethylenediamine tetraacetic acid was used to detect the carbapenems type.The strains whose enzyme type could not be determined were detected by colloidal gold immunochromatography.Results A total of 146 CRKP strains were detected,among which the highest detection rate was observed in respiratory specimen and from the Intensive Care Unit.Antimicrobial sensitivity results showed that the antimicrobial resistance rate of CRKP to beta-lactam antibiotics,carbapeemcarbapenem antibiotics,aztreonam was greater than 95%,while the drug resistance rate of ceftazidime/avibactam was 2.74%.Carbapenems screening test showed that 133 strains produced class A serinase,2 strains produced metallo-β-lactamase and 11 strains were uncertain.92.47% CRKP carbapenemase could be detected by Enzyme inhibitor enhancement test method.Conclusion CRKP in this hospital is severe,so it is necessary to timely monitor and rationally use drugs according to the results of antimicrobial sensitivity test.The main resistance mechanism of CRKP in this hospital is carbapenemase production,and the main carbapenemase is class A serinase.Clinical laboratories should reasonably optimize carbapenemase screening test to provide a direct basis for clinical precision antimicrobial use.
作者
陈福红
张思琴
杨玮
齐艳
CHEN Fu-hong;ZHANG Si-qin;YANG Wei;QI Yan(Department of Clinical Laboratory,Hangzhou Dingqiao Hospital,Dingqiao Ward of Hangzhou Hospital of Traditional Chinese Medicine,Zhejiang 310021,China;不详)
出处
《中国卫生检验杂志》
CAS
2023年第15期1831-1834,共4页
Chinese Journal of Health Laboratory Technology
基金
浙江省医药卫生科技计划项目(2020KY229)。
关键词
耐碳青霉烯肺炎克雷伯菌
耐药性
酶抑制剂增强试验
胶体金免疫层析法
Carbapenem-resistant Klebsiella pneumoniae
Antimicrobial resistance
Enzyme inhibitor enhancement test
Colloidal gold immunochromatography
