| Objectives:Analyze the distribution of clinical departments,specimen types and drug sensitivity changes of Enterobacter isolated from pathogenic microbiology laboratory in our hospital from 2016 to 2018,and provide a reference for clinicians to choose antibiotics and the type of specimens sent for inspection;Analyze the distribution of some drug resistance genes related to Enterobacter in our hospital from 2016 to 2018,and provide a methodological reference for monitoring the resistance of Enterobacter in the hospital.Furthermore,it can monitor the drug resistance changes of Enterobacter from the perspective of drug resistance genes,and guide clinical medication.Methods:1 Subjects:From January 2016 to December 2018,the outpatient and inpatients of our hospital were sent to the pathogenic microbiology laboratory for isolation and identification of all strains of Enterobacter.2 Collection of target strains:According to the version 2018 of the CLSI guideline,the ESBLs enzyme confirmation experiment was performed on the isolated and identified Enterobacter strains in the laboratory by using K-B paper diffusion method to obtain ESBLs positive Enterobacter strains.(For the same patient with the same drug-resistant strain detected multiple times,only the first drug-resistant strain was analyzed.)3 Analysis of drug resistance:Using WHONET5.6 software to analyze the information of Enterobacter strains exported by LIS system,and the changes of drug sensitivity,specimen type and clinical departments distribution of Enterobacter strains were counted.4 Analysis of drug resistance genes:The CTX-M-1 and SHV prim-ers were designed to perform PCR gene sequencing on ESBLs-positive Enterobacter strains,and the status of CTX-M-1 and SHV-mediated ESBLs resistance was analyzed.5 Statistical methods:SPSS21.0 software and SAS9.1.3 software were used to analyze the consistency of the drug sensitivity results of the target strains measured by K-B paper method and MIC method,and the difference in drug resistance rates between ESBLs positive strains and ESBLs negative strains.Results:1 From 2016 to 2018,the specimens of outpatient and inpatients of our hospital were sent to the microbiology room of the hospital.The strains initially isolated were identified and tested for drug sensitivity by the VITEK2 Compact automatic bacterial analyzer and the paper diffusion method,124 Enterobacter strains were obtained.Among them,1 strain of Enterobacter asburiae,22 strains of Enterobacer aerogenes,2 strains of Enerobacer gergoviae,and 99 strains of Enterobacter cloacae;Most of the target strains were isolated from neurosurgery(19%),urology(11%),intensive care department1(9%),and their specimen types are mainly sputum(56%),urine(17%),blood(10%).2 The top three drug resistance rates in 2016 were piperacillin(100%),aztreonam(95%),gentamicin(90.5%).The top three drug resistance rates in 2017 were Ceftriaxone(36.5%),piperacillin(34.9%),aztreonam(30.2%).The top three drug resistance rates in 2018 were ceftriaxone(31.4%),ceftazidime(25.5%),aztreonam(24.4%).Among them,the rate of drug resistance of Enterobacter in 2016 was higher than the national average.The rate of drug resistance of Enterobacter from 2017 to 2018 is roughly similar to the CRASS monitoring results,and some were even lower than the national average.3 There were 46 strains of Enterobacter strains by gene sequenced.Among them,6 were CTX-M-3 ESBLs(13%),10 were CTX-M-15 ESBLs(21.7%),8 were SHV12 ESBLs(17.4%),and mainly exists in Enterobac-ter cloacae.4 The results of statistical analysis:The drug sensitivity results of the target strain measured by K-B paper method and MIC method are in good agreement;The ESBLs enzyme produced by Enterobacter strains may be related to piperacillin and nitrofurantoin resistance.Conclusions:1 The drug resistance gene that mediates the Enterobacter ESBLs enzyme in our hospital:The group of CTX-M-1 group is CTX-M-3 and CTX-M-15 gene subtypes,the group of SHV is SHV-12 gene subtype.And the drug resistance of gene subtypes of the two groups mainly exist in Enterobacter cloacae.2 This study will help our hospital’s Department of Senses further improve the Enterobacter resistance "gene profile" and monitor the trend of drug resistance of Enterobacter from a genetic perspective,and guide the rational use of drugs in the clinic.3 Enterobacter in our hospital are mainly distributed in neurosurgery,urology,department of Intensive Medicine 1 ward,and mainly disseminated by sputum,urine,blood.Among them,the detection rate of Enterobac-ter cloacae was the highest.4 The resistance level of Enterobacter to various antibiotics in our hospital from 2016 to 2018 has shown a general downward trend.Compared with crass monitoring results for the same year,it was found that 2016 was slightly higher than the national average.In 2017-2018,the over all drug resistance trend was roughly similar or slightly lower than the national average,but there are also individual antibiotics resistance rates that are slightly higher than the national average. |
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