Abstract:

一直以来，流行性感冒（流感）是全人类重要的公共健康问题，发病率可列为各种传染性疾病之首，每年季节性流行造成的疾病负担高。全球每年季节性流感相关死亡人数达300万例以上，我国南方和北方地区每年5％～15％的人群感染，因流感到医院就医者超过50万人，超额死亡者达到20万例。

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ObjectiveTo understand the occurrence of healthcareassociated infection(HAI), distribution of pathogens, and drug resistance in a general hospital in 2014-2016, provide basis for prevention and control of HAI. MethodsClinical data of hospitalized patients from January 2014 to December 2016 were collected by prospective and retrospective investigation, distribution and drug resistance of pathogens causing HAI were statistically analyzed. ResultsFrom 2014 to 2016, 4 750 patients had 5 352 cases of HAI, incidence and case incidence of HAI were 2.19% and 2.46% respectively. Incidences of HAI in three years were 2.47%, 2.07%, and 2.05% respectively, showing a decreased tendency, difference was statistically significant (χ2=36.217，P＜0.01). Incidences of HAI were high in intensive care unit, department of neurosurgery, as well as department of burn and plastic surgery, the common HAI sites were respiratory tract, urinary tract, and surgical sites. The main pathogens causing HAI were gramnegative bacteria (76.10%). Resistance rates of Escherichia coli to cephalosporins and fluoroquinolones were relatively higher (>60%); resistance rates of Klebsiella pneumoniae to carbapenems were relatively higher; resistance rates of Pseudomonas aeruginosa to carbapenems showed a increased tendency year by year （χ2=15.175，P=0.001）；antimicrobial resistance rates of Acinetobacter baumannii were all>50%. Methicillinresistant Staphylococcus aureus(SA) accounted for about 60% of SA, methicillinresistant coagulase negative Staphylococcus(CNS) accounted for more than 80% of CNS, vancomycin and linezolidresistant Staphylococcus spp. were not found. ConclusionThe common pathogens causing HAI in this hospital are higher. Scientific monitoring on HAI and regular analysis of clinical data are of great significance for guiding rational use of antimicrobial agents, controlling multidrugresistant organisms, and reducing the occurrence of HAI.

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ObjectiveTo analyze the clinical distribution and antimicrobial resistance change trend of Acinetobacter baumannii（AB） from a geriatric hospital in 2013-2016. MethodsSpecimen source, department distribution, and antimicrobial resistance of AB isolated from all patients in the hospital from 2013 to 2016 were analyzed retrospectively. ResultsFrom 2013 to 2016, 1 712 strains of AB were isolated, AB isolation rates in 2013, 2014, 2015, and 2016 decreased year by year, which were 17.92%, 17.17%, 15.10%, and 11.81%, respectively. AB were mainly isolated from sputum (n=1 524, 89.02%), followed by urine (n=79, 4.61%) and blood (n=37, 2.16%). The main departments of AB isolation were intensive care unit (n=798, 46.61%), department of respiratory medicine (n=507, 29.62%), and neurology department (n=156, 9.11%). Resistance rates of AB to most antimicrobial agents increased in 2013-2016, resistance rates to compound sulfamethoxazole were low (25.68%-65.89%), followed by resistance rates to cefoperazone/sulbactam (54.74%- 68.00%), resistance rates to imipenem were 71.40%-77.42%, to the other antimicrobial agents were all>60%; in 2013-2016, resistance rates of AB to cefepime, cefoperazone /sulbactam, gentamicin, tobramycin, and compound sulfamethoxazole were significantly different (all P<0.05). ConclusionAntimicrobial resistance rates of AB in this hospital is increasing, it is necessary to strengthen the monitoring, promote the rational use of antimicrobial agents, and block the infection and transmission of AB in hospital.

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ObjectiveTo understand the risk factors for postoperative pulmonary infection in patients undergoing spinal surgery, and put forward the intervention measures. MethodsPatients who underwent spinal surgery in a hospital from May 2008 to June 2016 were analyzed retrospectively, they were divided into nonpulmonary infection group and pulmonary infection group according to whether they had postoperative pulmonary infection, clinical data of two groups were compared. ResultsA total of 612 patients who underwent spinal surgery were monitored, 43 had postoperative pulmonary infection, incidence of postoperative pulmonary infection was 7.03%. Univariate analysis showed that 14 risk factors for pulmonary infection in patients after spinal surgery were as follows: length of hospital stay≥30 days, longterm smoking, chronic pulmonary disease, diabetes, number of surgical level≥2, general anesthesia, duration of operation≥4 hours, bleeding≥500mL, time of bed rest≥7 days, use of glucocorticoid, indwelling urinary catheter, mechanical ventilation, serum albumin<30 g/L, blood glucose≥11mmol/L, and hemoglobin<90 g /L(P<0.05); while atomization inhalation was a protective factor( P＜0.05). Multivariate logistic regression analysis showed that 6 independent risk factors for pulmonary infection in patients after spinal surgery were as follows: length of hospital stay≥30 days, longterm smoking, chronic pulmonary disease, general anesthesia, time of bed rest≥7 days, and use of glucocorticoid(all P<0.05), while atomization inhalation was a independent protective factor( P＜0.05). ConclusionPatients with pulmonary infection after spinal surgery is related to multiple factors, comprehensive and effective preventive measures should be taken according to the risk factors of postoperative pulmonary infection, so as to reduce the incidence of postoperative pulmonary infection in spinal surgery patients.

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ObjectiveTo understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin, and find out optimal loading dose. MethodsSeverely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1, 2016 to February 28, 2017 were enrolled in the study. According to different drug loading doses (teicoplanin standard dose: 6mg/kg; high dose:10mg/kg) and different creatinine clearance rates (Ccr: 50mL/min as standard value), patients were divided into four subgroups: group of standard dose and normal Ccr (GSD1), group of standard dose and low Ccr (GSD2), group of high dose and normal Ccr ( GHD1), group of high dose and low Ccr(GHD2). Serum Cmin, percentage of achieving target concentration, and adverse reactions of teicoplanin in different groups were compared. ResultsA total of 49 patients were enrolled in the study, 17 patients were in GSD group, Cmin on 4th day before administration was (5.98±2.67)mg/L; 32 patients were in GHD group, Cmin on 4th day before administration was (9.05±4.25)mg/L; Cmin in GHD group was higher than that in GSD group, and there was statistical difference between two groups（t=3.10，P=0.003）. Values of Cmin in GSD1, GSD2, GHD1, and GHD2 groups were (5.78±2.72), (6.34±2.78), (8.21±3.77), and (12.07±4.81 ) mg/L respectively, differences among four groups were statistically significant（F=4.766, P=0.006）. The Cmin in GHD2 group was higher than those in GHD1,GSD2, and GSD1 groups, percentage of achieving the target concentration were 9.09% (1/11), 16.67% (1/6), 28.00%(7/25), and 71.43% (5/7) respectively, differences were statistically significant（χ2=8.766, P=0.033）. Complications associated with teicoplanin such as rash, damage to hepatic and renal function were not observed in all patients during the treatment course. ConclusionWhether the Ccr is normal or not, target Cmin can not be achieved early in patients given teicoplanin with standard loading dose; in patients with low Ccr, given high loading dose, target Cmin can be achieved early; while in patients with normal Ccr, higher loading dose may be needed. 

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ObjectiveTo explore the value of class 100 laminar flow ward in the prevention of infection in patients with hematological malignancies(HM) after chemotherapy. MethodsPatients with HM and received chemotherapy in the department of hematology in a hospital from March 2016 to February 2017 were surveyed retrospectively, according to patients’ wishes, those who were admitted to the class 100 laminar flow ward and received chemotherapy were as trial group, and those who were admitted to the common ward and received chemotherapy were as control group. The incidence of infection, duration of fever, antimicrobial use time, length of hospital stay, and index of infection were compared and analyzed between two groups. ResultsA total of 267 patients with HM received chemotherapy, 74 cases in trial group and 193 in control group. During the chemotherapy period, incidence of infection in trial group was lower than that of control group (47.3% vs 72.0%, P<0.001). Respiratory tract, digestive tract, and urinary tract were main infection sites in both groups. A total of 45 strains of pathogens were isolated from two groups of patients, 7 strains were isolated from trial group and 38 from control group. The isolated pathogens were Escherichia coli, Klebsiella pneumoniae, Stenotrophomonas maltophilia， Pseudomonas aeruginosa, and yeast. Duration of fever, antimicrobial use time, and length of hospital stay in trial group were all lower than control group(all P<0.05); serum procalcitonin (PCT) and Creactive protein (CRP) levels in trial group were both lower than control group(both P<0.01), the time for PCT and CRP to return to normal in trial group were both lower than control group(both P<0.05). ConclusionPatients with MH and receive chemotherapy in class 100 laminar flow ward can reduce the incidence of infection, shorten the length of stay, and reduce the economic burden, it is worthy of further clinical promotion.

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ObjectiveTo understand the distribution and drug resistance  of pathogenic bacteria from diabetic foot patients of different grades of Wagner classification, and provide basis for the rational use of antimicrobial agents in clinical practice. MethodsClinical data, pathogens isolated from wound secretion, and antimicrobial susceptibility testing result of diabetic foot patients who were admitted in the department of endocrinology in a hospital between January 2014 and December 2016 were analyzed retrospectively, patients were divided into grampositive (G+) bacteria infection group, gramnegative (G-) infection group, and mixed infection group according to the isolation of bacterial species, relationship between patients’ clinical characteristics and Wagner grades was analyzed. ResultsThere were 103 patients with diabetic foot, 39 with G+ bacterial infection, 50 with G- bacterial infection, and 14 with mixed infection. The age and disease course of patients with mixed infection was significantly elder and longer than the other two groups of patients(both P<0.05); glycosylated hemoglobin (HbA1c) and procalciton in mixed infection group were both lower than the other two groups(both P<0.05); the percentage of neutrophils in G+ infection group was higher than the other two groups（P＜0.01）. A total of 132 specimens were detected, 103 strains were isolated, the positive rate was 78.03%, isolation rates of G+ and G- bacteria were 33.33% (44/132) and 44.70% (59/132) respectively. The major G+ strains were Staphylococcus aureus(n=19) and Staphylococcus epidermidis(n=11), the major G- bacteria were Citrobacter braakii(n=12), Escherichia coli(n=11), and Pseudomonas aeruginosa(n=11). As the Wagner grade increased, the proportion of mixed infection continued to rise. The main multidrugresistant organisms were methicillinresistant Staphylococcus aureus  and extendedspectrum betalactamaseproducing G- strains. ConclusionFor diabetic foot patients, especially those with higher Wagner grades, etiological examination and antimicrobal susceptibility testing of ulcer secretion should be timely performed, so as to provide reference for rational use of antimicrobial agents in clinic.

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ObjectiveTo systematically evaluate the compliance and correct rate of hand hygiene(HH) among doctors and nurses in secondary and above hospitals in mainland China，and provide data support for HH promotion. MethodsLiteratures about study on HH in mainland China after 2015 were retrieved from Chinese and English databases, researchers evaluated the literatures according to the relevant standards, screened the qualified literatures and extracted the data strictly according to the inclusion and exclusion criteria, Meta analysis was adopted to analyze the compliance and the correct rate of HH of doctors and nurses in different levels of hospitals and at different departments.ResultsThe overall compliance rate of HH of nurses was higher than doctors, compliance rates of HH of doctors and nurses were 55.9% (95%CI: 45.9%, 65.8%) and 66.0%(95%CI: 58.8%, 73.1%） respectively；HH correct rates of doctors and nurses were 65.2% (95%CI: 53.6%, 76.9%) and 67.9%(95%CI: 56.9%, 78.9%) respectively. Compliance rates of HH of doctors and nurses in tertiary hospitals were both higher than secondary hospitals, compliance and correct rates of HH of doctors and nurses in intensive care unit were both higher than general departments.ConclusionThe compliance and correct rate of HH in mainland China need to be further improved, especially the promotion in primary hospitals and general departments.

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ObjectiveTo explore the necessity of opening nephrostomy tube for patients with septic shock following the indwelling doubleJ stent of postpercutaneous nephrolithotomy (PCNL), and provide reference for the treatment of septic shock after PCNL. Methods60 patients with septic shock after PCNL in a hospital from January 1, 2015 to December 30, 2016 were chosen, patients were randomly divided into clipping nephrostomy tube group (clipping group, n=30) and opening nephrostomy tube group (opening group, n=30), clinical data of two groups of patients were collected and analyzed. ResultsAfter 24hour treatment, heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), serum lactate (Lac), and hourly urine volume all improved in both groups of patient compared with pretreatment(all P<0.05); HR, MAP, SpO2, Lac, and hourly urine volume in opening group after 24hour treatment were all significantly different from clipping group (all P<0.05). Levels of serum procalcitonin (PCT) and Creactive protein (CRP) in two groups after 3day treatment decreased significantly compared with pretreatment (both P<0.05); PCT and CRP levels in opening group after 3day treatment were both significantly lower than clipping group (both P<0.05); cure rate of two groups were both 100.00%, hospitalization time and extubation time in opening group were both shorter than clipping group, and cost was less than clipping group, difference were all significant(all P<0.05). ConclusionOpening nephrostomy tube on the basis of indwelling doubleJ stent is necessary for patients with septic shock after PCNL.

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ObjectiveTo explore the risk factors for septicemia after cesarean section, and provide reference for clinical prevention of postoperative septicemia. MethodsClinical data of patients who underwent cesarean section in a maternal and child health hospital between January 1, 2013 and October 31, 2016 were collected by retrospective survey method, risk factors were analyzed by multivariate logistic regression model. ResultsA total of 4 604 cases of cesarean section were selected, 32 cases of septicemia occurred, incidence was 0.70%. Multivariate logistic regression analysis showed that there were seven independent risk factors for septicemia: gestational diabetes mellitus（OR=4.03）, trying vaginal delivery（OR=15.86）, No.of vaginal examination ≥3 times（OR=6.77）, premature rupture of membrane≥12 hours（OR=3.47）, intraoperative bleeding≥1 000 mL（OR=4.66）, postoperative duration of indwelling urinary catheter>24 hours（OR=2.83）, and antimicrobial use within a week（OR=3.20）. Four factors were protective factors: gestational weeks≥34 weeks（OR=0.20）, hemoglobin≥100 g/L（OR=0.40）, albumin≥35 g/L（OR=0.28）, and amniotic fluid volume at a normal level（OR=0.22）.ConclusionIt is possible to prevent and control the occurrence of septicemia after cesarean section through strict management of independent risk factors and intervention in protective factors of pregnant women during perioperative period.

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ObjectiveTo compare diagnostic value of four fungal scoring methods in invasive Candida infection, provide evidence for early diagnosis and treatment of invasive Candida infection. MethodsHighrisk patients with invasive Candida infection in the intensive care unit(ICU) in a hospital from 2011 to 2016 were analyzed retrospectively. According to diagnostic criteria, patients were divided into four groups: noninfection group, suspected infection group, clinically diagnosed group, and confirmed group, patients were conducted multidiseases risk assessment (MDRA) score, invasive fungal infections risk scoring system (IFIRSS ) score, Sevilla score, and Candida score, diagnostic value of four scoring methods for invasive Candida infection were evaluated. ResultsThere were 275 highrisk patients, 138 in noninfection group, 63 in suspected infection group, and 74 in infection group(clinically diagnosed group: n=64; confirmed group: n=10). The age and length of hospital stay in the infection group were all higher than noninfection group (both P<0.05). 74 strains of Candida were isolated from 74 infected patients, mainly Candida albicans (n=60, 81.1%). Positive rates for MDRA score, Candida score, Sevilla score, and IFIRSS score were 41.5%(n=114), 30.2%(n=83), 15.3%(n=42), and 8.4% (n=23) respectively. Of four MDRA scoring methods, MDRA had the higher sensitivity(Se, 59%) but lowest specificity(Sp, 66%); IFIRSS had higher Sp(91%) but very low Se (9%); Sevilla score had the highest Sp (96%）and higher Se(45%) ；Candida score had the highest Se（68%） and higher Sp (90%）. ConclusionSevilla score has higher Se and Sp, which can be used in early diagnosis of invasive Candida infection; Candida score has the highest coincidence with clinical diagnostic criteria for invasive Candida infection, both Se and Sp are high, which is of great value for early diagnosis of invasive Candida infection.

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ObjectiveTo analyze the clinical features of melioidosis， explore its diagnosis and treatment methods. Methods35 patients who were with pathogenic evidence of melioidosis and admitted in a hospital between March 2012 and February 2017  were analyzed retrospectively. ResultsOf 35 patients at admission, 2 (5.7%) were with confirmed culture result of melioidosis in the other hospitals, 3 (8.6%) highly suspected patients had relatively typical clinical features, 30 (85.7%) were misdiagnosed, suspected patients were all confirmed melioidosis through the cultured result of Burkholderia pseudomallei from all kinds of specimens. Through treatment of antiinfection, surgical drainage (11.4%) and operation (20.0%), 26 cases (74.3%) were improved or recovered, 2 (5.7%) abandoned treatment, and 7 (20.0%) died. The most common initial symptom was fever (88.6%), followed by cough（34.3%）, shortness of breath（28.6%）, abdominal pain (14.6%), extremity pain (11.4%), and joint pain (5.7%); the top five infection sites were blood (85.7%), lung (54.3%), spleen (20.0%), skin and soft tissue (20.0%), and liver (14.3%); 85.7% of Burkholderia pseudomallei were isolated from blood culture, 37.1% and 20.0% were isolated from all kinds of puncture fluid and sputum respectively. ConclusionClinical features of melioidosis are diverse, misdiagnosis rate is high. Early, timely, rational, and enough treatment course can reduce the mortality and recurrence rate of melioidosis.

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ObjectiveTo explore the necessity of setting up the course on clinical healthcareassociated infection(HAI) and effectiveness of the casebased teaching method in medical higher education. Methods198 students who underwent internship in a hospital between July 2015 and July 2016 were selected, according to whether they selected clinical HAI coures, they were divided into course selective group(n=107, adopted casebased teaching method ) and unselective group(n=91), questionnaire survey on the knowledge and attitude of HAI was carried out. ResultsThe average score on HAI in selective group was higher than that of unselective group(［85.3±1.6］ vs ［58.3±1.8］, t=111.72， P<0.01）. Before and after conducted casebased teaching method, 21.49% and 47.66% of students actively studied respectively, difference was significant (χ2=16.195, P<0.01). ConclusionIt is necessary to carry out a systematic course on HAI, casebased teaching method can improve the learning enthusiasm of students.

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ObjectiveTo explore the effect of multidisciplinary team (MDT) combined with bundle management on prevention and control of multidrugresistant organism (MDRO) infection in the intensive care unit(ICU). MethodsPatients who were admitted to the ICU in a tertiary firstclass hospital from January 2013 to December 2015 were studied, MDT combined with bundle management has been applied in the prevention and control of MDRO infection in ICU since January 2014, continuous quality improvement program was performed one year later, isolation of MDROs from specimens of ICU patients before implementation（in the year of 2013）, after implementation（in the year of 2014）, and after continuous quality improvement（in the year of 2015） was compared. ResultsThe infection rates of MDROs in ICU patients before implementation, after implementation, and  after continuous quality improvement were 26.55% (154/580), 17.13% (117/683), and 12.01% (77/641) respectively, showing a downward trend, with a significant difference (χ2=44.030, P<0.001); the total isolation rates of MDROs in ICU patients were 64.44%（154/239）, 63.59%（117/184）, and 43.26%（77/178）respectively，showing a downward trend, with a significant difference （χ2=22.284，P＜0.001）. The main MDROs in ICU were multidrugresistant(MDR) and pandrugresistant(PDR) Acinetobacter baumannii (44.54%). ConclusionMDT combined with bundle management can decrease MDRO infection rate and isolation rate  in ICU.

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ObjectiveTo investigate the effect of comprehensive intervention measures on submission of microbiological specimens before therapeutic use of antimicrobial agents. MethodsAugust 2014 to August 2015 was as preintervention group, comprehensive intervention measures were started to carry out from September 2015, September 2015 to September 2016 was as postintervention group. Microbiology specimen submission rates before therapeutic antimicrobial use, positive rate of blood culture, and rate of antimicrobial use in all departments and key departments were compared between preintervention group and postintervention group. ResultsThe submission rates of microbiological specimens before general, restricted, and special therapeutic antimicrobial use increased from 42.21%, 45.19%, and 74.71% of preintervention respectively to 53.54%, 55.68%, and 89.70% of postintervrntion respectively, showing significant difference (all P<0.01); after intervention, except gastrointestinal surgery and trauma department of orthopedics, the other departments all met the requirements of the microbiological specimen submission rates set by the hospital; but submission rates of microbiological specimens from department of gastrointestinal surgery and trauma department of orthopedics increased from 5.46% and 11.67% before intervention to 11.66% and 29.45% respectively after intervention, difference was statistically significant (both P<0.001). The missing report rate of healthcareassociated infection(HAI) dropped from 13.56% before intervention to 10.98% (P< 0.05), and the use rate of antimicrobial agents decreased from 57.36% to 54.47% (P<0.001). ConclusionComprehensive intervention measures can effectively improve the submission rates of microbiological specimens before therapeutic use of antimicrobial agents, reduce missing report rates of HAI and utilization rate of antimicrobial agents, and achieve certain clinical effectiveness.

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ObjectiveTo evaluate the effect of plandocheckact (PDCA) cycle management method on improving multidrugresistant organisms (MDROs) prevention and control measures. MethodsPDCA cycle management method was applied to improve the management system and management process of a hospital, prevention and control efficacy of MDROs in clinic departments between JulyDecember 2014 (before PDCA implementation) and JanuaryJune 2015 (after PDCA implementation) was compared. ResultsAfter half a year implementation of PDCA cycle management, the total implementation rate of MDROs prevention and control measures increased from 57.14% (360/630) to 79.69% (510/640), difference was statistically significant(P<0.05); implementation rate of recording by doctors during the disease course , recording by nurses during the nursing process, registration and reporting of MDROs, as well as posting isolation signs were all improved, difference was statistically significant (all P< 0.05). The total isolation rate of MDROs declined from 30.65%（347/1 132）before PDCA implementation to 22.61%（236/1 044） after PDCA implementation, difference was statistically significant（χ2=10.393， P＜0.05). ConclusionApplication of PDCA cycle can improve the prevention and control measures of MDROs.

Abstract:

目的分析某院医院感染防控成本，为进行医院感染管理成本效果与成本效益研究提供基础数据支持。方法采用直接成本法，查阅文献并结合某三甲综合医院的实际情况制作成本核算表，列出调查的项目，包括医院感染管理科、消毒供应中心、医疗废物处置中心全部人力及物力投入，以及临床科室的部分投入，收集各项目的数量、单价及总费用，计算各项目的构成比。结果2015年该院医院感染防控成本总投入为2 498.23万元，每出院人次医院感染防控成本为300.99元（2 498.23万元/8.3万），每人次每住院日医院感染防控成本为33.44元（300.99元/9 d）。医院感染防控成本构成中占比最大的为消毒供应中心（1 748.50万元，占69.99%），其次是临床科室（362.27万元，占14.50%）、医院感染管理科（225.85万元，占9.04%），最低为医疗废物处置中心（161.61万元，占6.47%）。结论该院医院感染防控直接成本较高，主要是消毒供应中心的消耗材料成本，医疗废物处置相关投入也需引起关注。

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伏立康唑属三唑类抗真菌药，抗菌谱较广，对假丝酵母菌包括耐氟康唑的克柔假丝酵母菌、光滑假丝酵母菌和白假丝酵母菌耐药菌株以及曲霉菌、隐球菌等均具抗菌活性。推荐用于治疗免疫功能减退患者进行性的、可能威胁生命的感染。其常见的不良反应为视觉障碍、皮疹及肝功能检验值异常等，停药后症状消失。伏立康唑引起急性肝衰竭的发生率较低，其肝毒性机制可能与个体特异性有关［1］，也可能与慢性基础肝病史有关［2］。2017年5月某院收治1例乙型肝炎病毒（HBV）携带者应用伏立康唑治疗鼻窦、颅内曲霉菌感染过程中出现急性肝衰竭的患者，现将其治疗过程进行总结，以警示临床医务人员。

Abstract:

肠杆菌科细菌是医院和社区感染最常见的病原菌，可引起多部位炎症，如肺炎、泌尿系统炎症、败血症、腹膜炎、医疗器械相关性感染等。由于几乎可水解所有头孢菌素的超广谱β内酰胺酶（ESBLs）在肠杆菌科细菌中的流行，对于重症感染患者，碳青霉烯类作为最有效的抗菌药物被广泛使用。随着碳青霉烯类药物消耗量的增加，耐药菌株开始出现，并在全球范围快速传播［12］。耐碳青霉烯肠杆菌科细菌（carbapenemresistant Enterobacteriaceae,CRE）通常表现对β内酰胺类药物高水平抵抗，同时伴随着对多种其他抗菌药物，如氨基糖苷类、氟喹诺酮类等耐药，使治疗成为十分棘手的问题。