临沂地区临床CRE菌株的耐药表型与碳青霉烯酶耐药基因型的特征分析-现代医学

临沂地区临床CRE菌株的耐药表型与碳青霉烯酶耐药基因型的特征分析

单位：1. 锦州医科大学临沂市人民医院研究生培养基地, 辽宁锦州 121000;
2. 临沂市人民医院检验医学中心, 山东临沂 276000

分类号：R446.5

出版年·卷·期（页码）：2026·54·第一期（49-55）

摘要：

目的：针对临沂地区耐碳青霉烯类肠杆菌(CRE)的临床流行病学特征展开分析，聚焦菌株分布、耐药表型及耐药基因型，为本区域感染防控与临床合理用药提供证据支持。方法：收集2023年1月至2024年9月临沂市人民医院临床分离的104株CRE菌株，综合运用病原学鉴定、药敏试验及分子生物学法对菌株进行检测分析。结果：104株CRE中以肺炎克雷伯菌(71.16%)为主，其次为大肠埃希菌(20.19%)；重症监护室为CRE检出的主要科室(47.12%)。药敏结果显示，CRE菌株对厄他培南、头孢呋辛、头孢呋酯、头孢曲松、头孢噻肟以及β-内酰胺酶抑制剂复合制剂氨苄西林/舒巴坦均表现出完全耐药(耐药率100%)。mCIM和eCIM表型检测结果显示，mCIM阳性95株，阴性9株，95株mCIM阳性菌株中20株为eCIM阳性。耐药基因检测中，bla_KPC基因检出率最高(65.38%)，其次为bla_NDM(19.23%)和bla_OXA-48(5.77%)基因。结论：肺炎克雷伯菌及大肠埃希菌系临沂CRE感染优势菌种，且对多种抗菌药物耐药，bla_KPC、bla_NDM与bla_OXA-48基因为核心耐药机制。临床应加强对此类易感人群的防护。

Objective: To analyze the clinical epidemiological characteristics of carbapenem-resistant Enterobacterales(CRE) in Linyi region, with a focus on strain distribution, drug resistance phenotypes and resistance genotypes, so as to provide evidence for local infection prevention and control as well as rational clinical medication use. Methods: A total of 104 clinical CRE isolates were collected from Linyi People's Hospital during January 2023 to September 2024. All strains were detected and analyzed by comprehensive application of etiological identification, antimicrobial susceptibility testing and molecular biological methods. Results: Among the 104 CRE strains, Klebsiella pneumoniae was the predominant species(71.16%), followed by Escherichia coli(20.19%). The intensive care unit was the primary department with the highest CRE detection rate(47.12%). Antimicrobial susceptibility testing results indicated that all CRE strains were completely resistant to ertapenem, cefuroxime, cefuroxime axetil, ceftriaxone, cefotaxime, and the β-lactamase inhibitor combination ampicillin/sulbactam, with a resistance rate of 100%. Results of modified carbapenem inactivation method(mCIM) and enhanced carbapenem inactivation method(eCIM) phenotypic assays indicated 95 mCIM-positive strains and 9 mCIM-negative strains, among which 20 strains were eCIM-positive among the 95 mCIM-positive isolates. For resistance gene detection, the detection rate of bla_KPC gene was the highest(65.38%), followed by bla_NDM(19.23%) and bla_OXA-48(5.77%) genes. Conclusion: Klebsiella pneumoniae and Escherichia coli are the dominant pathogens responsible for CRE infections in Linyi region, and these strains exhibit resistance to multiple antimicrobial agents. The bla_KPC,bla_NDM and bla_OXA-48 genes are the core resistance mechanisms. Clinical practice should prioritize enhanced protection for populations susceptible to such infections.

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