儿科耐碳青霉烯类肠杆菌科细菌携带β-内酰胺酶基因的调查  

Survey of the genotypes of beta-lactamases carried by carbapenems resistant Enterobacteriaceae isolated from children

作　　者：刘彩霞[1] 严春 李方去[1] 张盼[1] 

机构地区：[1]温州医科大学附属第二医院,浙江温州325000 [2]温州市儿童医院,浙江温州325000

出　　处：《疾病监测》2015年第1期67-70,共4页Disease Surveillance

基　　金：温州市科技局项目(No.Y20140045)~~

摘　　要：目的调查温州医科大学附属第二医院儿科耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant enterobacteriaceae,CRE)携带β-内酰胺酶基因的情况,同时分析细菌的药物敏感性,指导临床合理使用抗菌药物。方法采用全自动微生物鉴定系统对菌株进行鉴定和药敏;用改良Hodge试验进行产碳青霉烯酶检测;用聚合酶链反应方法扩增β-内酰胺酶基因,包括blaKPC、blaTEM、blaSHV、blaIMP-1、blaIMP-2、blaVIM-1、blaVIM-2、blaCTXM-1、blaCTXM-2、blaCTXM-9和blaNDM-1。结果 2011年1月至2012年12月该院儿科共分离到13株CRE。对常用的β-内酰胺类抗菌药物及其酶抑制剂均耐药,对复方新诺明耐药率达100%,对阿米卡星的耐药率最低,为7.69%,其次为妥布霉素为15.38%。所有菌株均检测到blaTEM,blaKPC的检出率达84.62%,blaSHV、blaCTXM-1、blaCTXM-9和blaVIM-1的检出率分别为46.15%、46.15%、15.38%和7.69%。结论温州医科大学附属第二医院儿科CRE菌株主要携带的β-内酰胺酶基因为blaTEM、blaKPC和blaSHV,产KPC型碳青霉烯酶是儿科CRE对碳青霉烯类抗菌药物耐药的主要原因;该类细菌均表现为多重耐药,阿米卡星可作为该类细菌引起感染的首选药物。Objective To understand the genotypes of beta-lactamases carded by carbapenems resistant Enterobacteriaceae （CRE） isolated from sick children in our hospital and the susceptibility of CRE to antibiotics. Methods The identification and drug susceptibility test of the strains were performed with VITEK compact-2 automatic system. Carbapenemase was detected by using Modified Hodge test. β-1actamase genes, including blaKPC, blaTEM, blaSHV.blaIMP-1, blaIMP-2, blaVIM-1, blavVIM-2, blaCTXM-1, blacCTXM-2, blaCTXM-9 and blaNDM-1, were detected by PCR and confirmed by sequencing. Results A total of 13 strains of CRE were collected from January 1,2010 to December 31, 2012. All the strains were resistant to β-1actarns, β-1actamase inhibitor. The resistant rate to cotrimoxazole was 100%, the resistance rate to tobramycin was 15.38% and the resistant rate to amikacin was 7. 69%. PCR results indicated that all the strains carried blaTEM gene, 11 strains （84. 62% ） carried blaKPC gene, and the detection rates of blaSHV.blaCTXM-1 , blaCTXM-9 and blaVM-1, genes were 46. 15%, 46. 15%, 15. 38% and 7. 69%, respectively. Conclusion Klebsieila pneumoniae carbapenemase producing was the main reason for CRE resistance to carbapenems in our hospital. Most CRE strains were multi drug resistant. Amikacin can be the first choice for treatment of CRE infection.

关 键 词：儿童 肠杆菌科细菌 Β-内酰胺酶 碳青霉烯酶 

分 类 号：R446.5[医药卫生—诊断学]