背景:为了确保头孢他啶-阿维巴坦(CAZ-AVI)的适当使用,最近在我们医院介绍,我们的目标是确定敏感率,酶分析,和菌株之间的克隆关系,以及临床数据。
方法:在2021年6月1日至9月30日之间,记录患者的人口统计学和微生物学数据。在获得的样品中,美罗培南和粘菌素最小抑制浓度(MIC)水平,碳青霉烯抗性基因,并通过分子方法研究了克隆关系。CAZ-AVI未用于任何患者。
结果:从57例患者中分离出140例碳青霉烯类耐药肺炎克雷伯菌。在76株(54.3%)菌株中发现了对CAZ-AVI的抗性。57名患者中,可达到31株(54.4%)。美罗培南MIC水平≥32µg/mL,26例(83.9%),17个(54.8%)分离株的粘菌素MIC水平≥4µg/mL。酶分析显示NDM中有20例(64.5%),OXA-48在17(54.8%),和KPC在七个(22.6%)中。在10个(32.2%)菌株中测定NDM+OXA-48。在所有CAZ-AVI耐药菌株中测定NDM,16.1%(2/5)的OXA-48菌株。检测到7种基因型。最大的簇是基因型3簇(11个分离株)。31名患者中,22人(71.0%)死亡。CAZ-AVI在一名存活的患者和四名死亡的患者中易感。
结论:在使用新的抗生素之前,各中心应确定该抗生素特有的基础数据和表型/基因型耐药比.虽然高NDM率和低CAZ-AVI敏感性限制了该药物在我们中心的使用,显然,在敏感菌株中使用CAZ-AVI将降低死亡率。
BACKGROUND: To ensure the appropriate usage of ceftazidime-avibactam (CAZ-AVI), recently introduced in our hospital, we aimed to determine susceptibility rates, enzyme analysis, and clonal relationship among strains, together with clinical data.
METHODS: Between June 1 and September 30, 2021, demographic and microbiological data of the patients were recorded. In the obtained samples, meropenem and colistin minimal inhibitory concentration (MIC) levels, carbapenem resistance genes, and the clonal relationship were studied by molecular methods. CAZ-AVI was not used in any of the patients.
RESULTS: 140 carbapenem-resistant Klebsiella pneumoniae were isolated from 57 patients. Resistance to CAZ-AVI was found in 76 (54.3%) strains. Out of 57 patients, 31 (54.4%) isolates could be reached. Meropenem MIC level was ≥ 32 µg/mL in 26 (83.9%), and colistin MIC level was ≥ 4 µg/mL in 17 (54.8%) isolates. Enzyme analysis revealed NDM in 20 (64.5%), OXA-48 in 17 (54.8%), and KPC in seven (22.6%). NDM + OXA-48 was determined in 10 (32.2%) strains. NDM was determined in all CAZ-AVI resistant strains, OXA-48 in 16.1% (2/5) strains. Seven genotypes were detected. The largest cluster was genotype 3 clusters (11 isolates). Of 31 patients, 22 (71.0%) died. CAZ-AVI was susceptible in one of the patients who survived and four who died.
CONCLUSIONS: Before using a new antibiotic, each center should determine the basal data and phenotypic/genotypic resistance ratios specific to that antibiotic. While a high NDM rate and low CAZ-AVI sensitivity limit the use of the drug in our center, it is clear that CAZ-AVI use in sensitive strains will decrease mortality.