| Objective1.To understand the drug susceptibility of Enterobacteriaceae in Henan Province in 2021 and the drug resistance characteristics of each region in Henan Province,so as to provide scientific basis for rational use of antibiotics in clinic.2.To investigate the drug sensitivity of carbapenem-resistant Enterobacteriaceae to common clinical antibiotics and ceftazidime/avibactam in some hospitals in Henan Province in 2021,so as to provide scientific basis for clinical rational selection of antibiotics.3.To investigate the drug resistance characteristics and mechanism of ceftazidime/avibactam-resistant Enterobacteriaceae in Henan province,and to provide scientific and effective experimental basis for clinical treatment of drug resistance in Henan province.Methods1.The WHONET 5.6 software was used to analyze the basic situation,drug resistance and the testing of carbapenem-resistant Enterobacteriaceae from 98 hospitals in different cities of Henan Province in 2021,and to analyze the drug resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems,polymyxin and tigecycline in different regions of Henan Province.The drug resistance rates of Enterobacteriaceae to carbapenems,polymyxin and tigecycline in secondary and tertiary hospitals in Henan Province were analyzed.SPSS 26.0 software was used for statistical analysis.Chi-square test was used to compare drug resistance in different regions and second and tertiary hospitals in Henan province,withα=0.05 as the test level.2.A total of 284 carbapenem-resistant Enterobacteriaceae strains were analyzed in 12 hospitals in Henan Province from January 2021 to December 2021.The clinical data and strain distribution of the collected strains were analyzed.The minimum inhibitory concentrations of 12 commonly used antibiotics were determined by the broth microdilution method.3.Twenty-nine isolates of ceftazidime/avibactam resistant Enterobacteriaceae were preliminarily screened for serine and metalloenzymes by carbapenemase inhibitor enhancement test.Klebsiella pneumoniae carbapenemase（KPC）、New Delhi metal-β-lactamase（NDM）、Verona integron-encoded、metallo-β-lactamase（VIM）,Imipenemase（IMP）and oxacillinase-48（OXA-48）were detected by enzyme immunochromatography and polymerase chain reaction.Results1.A total of 58229 Enterobacteriaceae strains were detected in 98 hospitals in Henan Province in 2021,of which 4.6%（2686/58229）were in outpatient and emergency departments,and 95.4%（55543/58229）were in inpatients.The main sources of isolated specimens were respiratory tract（38.3%,22302/58229）and urine（16.9%,9841/58229）.Enterobacteriaceae had high resistance rates to penicillins and cephalosporins,but low resistance rates to carbapenems,tigecycline and polymyxin.The detection rate of Carbapenem-resistant Enterobacteriaceae（CRE）in Henan province was 10.3%（5994/58229）.Among them,Carbapenem-resistant Escherichia coli（CREC）and Carbapenem-resistant Klebsiella pneumoniae（CRKP）were detected was 1.9%（488/25164）and 20.9%（3999/19102）,respectively,and the detection rate of other carbapenem-resistant Enterobacteriaceae was low.The detection rate of CREC was the highest in eastern Henan（3.6%,77/2134）and the lowest in southern Henan（1.1%,70/6343）.The detection rate of CRKP was the highest in central Henan（22.8%,1122/4921）,and the lowest in eastern Henan（14.0%,261/1864）.There were significant differences in the detection rate among different regions（P<0.05）.The resistance rate of Klebsiella pneumoniae to carbapenems and tigecycline in tertiary hospitals was significantly higher than that in secondary hospitals（P<0.05）,but the resistance rate of polymyxin in tertiary hospitals was lower than that in secondary hospitals（P<0.001）.There was no significant difference in the resistance rate of Escherichia coli to tigecycline between the secondary and tertiary hospitals,but the resistance rate of Escherichia coli to carbapenems and polymyxin in the secondary hospitals was significantly higher than that in the tertiary hospitals（P<0.05）.2.Ceftazidime/avibactam had high antibacterial activity against CRKP and CREC,with MIC50 and MIC90 of 1/4μg/m L,32/4μg/m L and 1/4μg/m L,128/4μg/m L,respectively.The resistance rates to tigecycline and polymyxin B were low,and no CREC resistant to tigecycline and polymyxin B was detected.The resistance rate toβ-lactam antibiotics,cephalosporins,aminoglycosides and other antibiotics was high,and the resistance rate toβ-lactam antibiotics was as high as 100%.3.The majority of ceftazidime/avibactam（CAZ/AVI）resistant Enterobacteriaceae in Henan Province were NDM enzyme producing（75.9%,22/29）,and the main genotype was bla NDM-1.Some Klebsiella pneumoniae may be resistant to CAZ/AVI due to the high expression of bla KPC-2.Conclusions1.The strain samples in Henan Province mainly reflect the infection situation of hospitalized patients,and the strain samples mainly come from respiratory tract and urine,suggesting that clinicians should not only consider the infection type of patients and the consensus requirements of treatment measures,but also refer to the local drug resistance monitoring data when using experientially.2.The problem of clinical drug resistance of Enterobacteriaceae in Henan Province is serious, especially carbapenem-resistant Klebsiella pneumoniae.In the same year,the national detection rate level was lower than its detection rate,and there are significant differences in different regions and hospitals of different levels in Henan province.It is suggested that relevant departments should strengthen the management of antibiotics in combination with hospital infection and strictly check the empirical drug use guidelines.3.CRE in Henan Province showed high sensitivity to ceftazidime/avibactam,tigecycline and polymyxin B,suggesting that related drugs should be carefully selected in clinical medication,and the emergence of drug-resistant bacteria should be vigilant..4.The resistance rate of Klebsiella pneumoniae and Escherichia coli to CAZ/AVI was low.Metalloenzyme production was the main reason for the resistance of Enterobacteriaceae to CAZ/AVI.Some Klebsiella pneumoniae might be resistant to CAZ/AVI due to the high expression of bla KPC-2.Enzyme type and gene detection of CRE is necessary to guide clinical experience medication in time. |
PDF Full Text Request