耐碳青霉烯类肠杆菌科细菌的耐药特征及基因分型  

Drug resistance characteristics and genotyping of carbapenem-resistant Enterobacteriaceae

作　　者：李进[1] 黎敏[1] 刘雯瑜 张策 邓少丽[1] 黄庆 鲁卫平[1] LI Jin;LI Min;LIU Wen-yu;ZHANG Ce;DENG Shao-li;HUANG Qing;LU Wei-ping(Daping Hospital of Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院野战外科研究所检验科,重庆400042 [2]陆军军医大学基础医学院,重庆400038

出　　处：《中华医院感染学杂志》2018年第24期3681-3684,共4页Chinese Journal of Nosocomiology

基　　金：全军后勤计划重大专项基金资助项目(AWS14C003-2)

摘　　要：目的研究耐碳青霉烯肠杆菌科细菌的耐药特征及基因分型,为研究耐碳青霉烯类肠杆菌科细菌的耐药机制提供实验依据。方法收集重庆某三甲医院2017年1月-2017年12月临床分离的81株耐碳青霉烯类肠杆菌科细菌,采用聚合酶链反应(Polymerase chain reaction,PCR)法检测KPC、IMP、VIM、NDM和OXA-48共5种主要的碳青霉烯酶耐药基因并行测序验证,并利用VITEK-MS质谱仪对所有菌株进行鉴定,采用最小抑菌浓度(minimal inhibitory concentration,MIC)法测定其对15种常用抗生素的敏感性,通过WHONET 5.6软件对药敏资料进行统计分析。结果 81株耐碳青霉烯类肠杆菌科细菌中有73株确定为产碳青霉烯酶,其中KPC型51株、NDM型14株、IMP型8株,未检出VIM型和OXA-48型耐药基因;其中肺炎克雷伯菌61株、大肠埃希菌5株、阴沟肠杆菌4株、弗劳地枸橼酸杆菌3株,分别来自ICU 37株、神经外科10株、康复科7株、RICU 6株、NICU 6株、CCU 4株、创伤外科3株;73株临床分离菌对头孢唑林、氨苄西林/舒巴坦、氨曲南和亚胺培南耐药率均高达100.0%,对头孢曲松、头孢他啶、头孢吡肟、头孢替坦和复方新诺明均>90.0%。结论医院患者临床分离的耐碳青霉烯类肠杆菌科细菌对多种抗菌药物的耐药率较高,且大多数的耐碳青霉烯类肠杆菌科细菌均携带有耐药基因,临床应加强对耐碳青霉烯类肠杆菌科细菌的监测和控制,合理选用抗生素。OBJECTIVE To study the drug resistance characteristics and genotyping of carbapenem-resistant Enterobacteriaceae and to provide experimental evidence for studying the resistance mechanism of carbapenem-resistant Enterobacteriaceae.METHODS A total of 81 strains of carbapenem-resistant Enterobacteriaceae were isolated from Jan.2017 to Dec.2017 in a grade-A tertiary hospital in Chongqing.Five major carbapenems resistance genes(KPC,IMP,VIM,NDM and OXA-48)were detected by polymerase chain reaction(PCR)and sequenced,and all the isolates were identified by VITEK-MS.The minimal inhibitory concentration(MIC)method was used to determine the susceptibility to 15 kinds of commonly used antimicrobial agents.The data of antimicrobial susceptibility were statistically analyzed by WHONET5.6 software.RESULTS 73 strains among 81 carbapenem-resistant Enterobacteriaceae were found to produce carbapenemases,including 51 strains of KPC type,14 strains of NDM type,and 8 strains of IMP type,whereas the VIM type and OXA-48 type were not detected.There were 61 strains of Klebsiella pneumoniae,5 strains of Escherichia coli,4 strains of Enterobacter cloacae,and 3 strains of Francobacterium brevifolia.37 strains were from ICU,10 strains from neurosurgery department,7 strains from rehabilitation department,6 strains from RICU,6 strains from NICU,4 strains from CCU,and 3 strains from trauma surgery.The resistance rates of all 73 clinical isolates were 100.0%to cefazolin,ampicillin/sulbactam,aztreonam and imipenem,and higher than 90.0% to ceftriaxone,ceftazidime,cefepime and cotrimoxazole.CONCLUSION The antimicrobial resistance rates of nosocomial carbapenem-resistant Enterobacterium were relatively high,and most of the isolates carried drug resistance genes.The surveillance and control of carbapenem-resistant Enterobacteriumshould be strengthened in clinic,and antimicrobial agents should be rationally selected.

关 键 词：肠杆菌科细菌 碳青霉烯酶 耐药特征 基因型 

分 类 号：R446.5[医药卫生—诊断学]