携带NDM-1阴沟肠杆菌尿路感染株临床特点回顾性报告  

Retrospective report of clinical characterizations of an Enterobacter cloacae carrying NDM-1 associated with urinary tract infection

作　　者：曹丽军[1] 杨靖 耿凤珍[1] 李慧卿[1] 史峥[1] 时东彦[3] 

机构地区：[1]河北大学附属医院检验科,河北保定071000 [2]河北省临床检验中心,河北石家庄050000 [3]河北医科大学第二医院,河北石家庄050000

出　　处：《医学研究与教育》2014年第1期33-36,共4页Medical Research and Education

摘　　要：目的对2012年7月分离自住院患者尿液标本携带NDM-1阴沟肠杆菌的临床特点、检测过程进行回顾性分析,探讨其耐药特征及产生机制,对控制"超级细菌"的流行提出意见。方法依照CLSI标准,采用K-B法和MIC法检测耐药性,改良Hodge试验和金属酶试验检测产酶类型,聚合酶链反应(PCR)检测耐药基因并进行测序。结果此株阴沟肠杆菌对亚胺培南和美罗培南等15种7个类别抗生素均显示耐药,改良Hodge试验阳性,金属酶表型初筛试验阳性,经基因扩增并测序后,与Genebank比对,表明与NDM-1基因有99%的相似性,并经河北省CDC确证报告该菌株为携带NDM-1阴沟肠杆菌。结论该尿路感染携带NDM-1基因金属酶的阴沟肠杆菌株,其产生可能与患者年老体差、恶性肿瘤伴长时滞留尿管并长时多次应用过多种抗生素有关,因此特别强调严格侵入性导尿及滞留时限指征、规范抗生素使用,做好重点消毒、隔离,控制多重耐药株发生。Objective A retrospective analysis in terms of clinical characteristics and detection was carried out for a case of Enterobacter cloacae bearing NDM-1 isolated from a urine specimen of an in-patient in our hospital in July 2012. The purpose of this paper was to render suggestions for controlling the epidemic of“superbugs”based on discussions regarding its antibiotic-resistant characterization and mechanism. Methods According to the recommendations of CLSI, susceptibility testing for antibiotics using K-B and MIC methods was performed. Carbapenemase production and its phenotypic were confirmed by modified Hodge test and metal-enzyme test. PCR for detecting and sequencing the antibiotic-resistance gene was also performed. Results This isolate was resistant to 15 antibiotics such as imipenem, meropenem and others which were classiifed into 7 categories. This isolation showed positive for modiifed Hodge test and screening test for detecting metal-enzyme phenotype. The DNA sequence of the isolation amplified by PCR showed 99%similarities comparing with NDM-1 gene cited in Genbank. It was conifrmed as the ifrst report of E. cloacae carrying NDM-1 by the CDC of Heibei Province.Conclusion The NDM-1-producing isolation may be related to the elder patient who was inifrm, catheterized and experienced multi-drug treatments. Therefore, in order to lessen the incidents of multi-drug resistant strain, it is ideal that we should focus on the control over catheterization, the use of antibiotics and taking strict sterilization.

关 键 词：阴沟肠杆菌 碳青霉烯类抗生素 NDM-1基因检测 回顾性报告 

分 类 号：R446[医药卫生—诊断学]