2008-2011年肠杆菌科细菌耐药性变迁及对碳青霉烯类抗生素的耐药机制  

Migration and mechanism of resistance of Enterobacteriaceae to carbapenems from 2008 to 2011

作　　者：蔡壬辛[1] 黄彬[1] 陈树林[1] 陈茶[2] 林冬玲[2] 何秋莹[1] 袁慧[2] 张妮[2] 房承才[2] 

机构地区：[1]中山大学附属第一医院检验医学部,广东广州510080 [2]广东省中医院检验医学部,广东广州510120

出　　处：《中国微生态学杂志》2013年第7期800-804,809,共6页Chinese Journal of Microecology

摘　　要：目的研究临床分离的肠杆菌科细菌的耐药性变迁和对碳青霉烯类药物不敏感的肠杆菌科细菌(CNSE)的耐药机制,为抗感染治疗提供依据。方法应用VITEK-2型全自动微生物检测系统对细菌进行鉴定及药敏试验,用PCR法检测A、B、D类碳青霉烯酶基因和esbls基因,并用核酸测序法进行验证。结果 2008-2011年共分离肠杆菌科细菌4154株,四年间对碳青霉烯类药物的耐药率并未显著升高(P>0.05)。对于CNSE而言,氨基糖苷类抗生素特别是阿米卡星的敏感率最高,在90%以上。从338株CNSE中随机挑选出182株进行耐药基因的检测,esbls基因tem、ctx-M、shv和碳青霉烯酶基因kpc、imp的阳性率分别为36.8%、31.9%、19.8%、2.2%和3.3%。kpc和imp主要在肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌中检出,未检出其他碳青霉烯酶耐药基因,包括ndm-1基因。结论肠杆菌科细菌对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦仍保持高度敏感。CNSE对碳青霉烯类药物敏感性降低是多种耐药机制共同作用的结果,ndm-1不是导致肠杆菌科细菌对碳青霉烯类药物敏感性降低的原因。Objective To investigate the drug resistance of Enterobacteriaceae strains isolated from the First Affiliated Hospital of Sun Yat-sen University during 2008 to 2011,and the resistant mechanisms of carbapenems-non-susceptible Enterobacteriaceae（CNSE）.Methods The strain identification and antibiotic susceptibility were analyzed by VITEK-2 automatic analyzer.Different molecular classes（A,B and D） of carbapenemase genes and extended spectrum β-lactamases（esbls） genes were detected by PCR and confirmed by sequencing.Results A total of 4154 Enterobacteriaceae isolates were analyzed.There were no significant differences in the proportions of carbapenem-resistant Enterobacteriaceae during the four years（P〉0.05）.338 CNSEs showed the highest sensitivity to aminoglycoside antibiotics especially amikacin.182 isolates were randomly chosen for PCR.The positive rates of the detected genes were as following： tem（36.8%）,ctx-M（31.9%）,shv（19.8%）,blaKPC（2.7%）,blaIMP（3.3%）.The kpc and ipm were detected out in Klebsiella pneumoniae,Enterobacter cloacae and Escherichia coli.No other carbapenem resistant genes,including ndm-1,were found.ConclusionCarbapenems,amikacin and piperacillin/tacobactam are still the effective antibacterial agents for the treatment of Enterobacteriaceae infection.Carbapenemase and esbls may lead to the reduction of susceptibility to carbapenems in Enterobacteriaceae,The ndm-1 is not the cause of Enterobacteriaceae resistance to carbapenems.

关 键 词：肠杆菌科细菌 CNSE 耐药性 NDM-1 

分 类 号：R378.2[医药卫生—病原生物学]