泌尿系感染多重耐药肠杆菌科细菌分子流行病学分析  

Urinary System Infection of Multidrug-resistant Enterobacteriaceae: A Molecular Epidemiology Analysis

作　　者：云长缨 吴多荣[2] 黄会[2] 黄增光[3] 佘姝敏 

机构地区：[1]海南省海口市疾病预防控制中心,571100 [2]海口市人民医院 [3]广州医科大学附属第一医院

出　　处：《中国全科医学》2015年第11期1322-1325,1329,共5页Chinese General Practice

基　　金：海口市重点科技计划项目(2012-070)

摘　　要：目的了解海南地区泌尿系感染多重耐药肠杆菌科细菌的流行特点及耐药机制。方法收集海南地区4家三级综合医院(海南省人民医院、海口市人民医院、海南农垦总局医院和三亚市人民医院)2012年1月—2013年8月门诊和住院泌尿系感染患者清洁中段尿分离的多重耐药肠杆菌科细菌225株,采用VITEK 2 compact微生物分析仪进行细菌鉴定和药敏试验,采用确证试验检测超广谱β-内酰胺酶(ESBLs),采用改良Hodge试验(MHT)和金属酶筛选(MBL)试验对碳青霉烯类不敏感菌株进行碳青霉烯酶表型确认,对于阳性菌株采用PCR扩增分别进行ESBLs、KPC酶、IPM酶和NDM-1基因型检测,并对扩增产物进行测序。结果 225株多重耐药肠杆菌科细菌中产ESBLs的细菌203株(90.2%),其中大肠埃希菌163株、肺炎克雷伯菌32株、产酸克雷伯菌4株、奇异变形杆菌4株;其他多重耐药肠杆菌科细菌22株(9.8%)。药敏试验发现对碳青霉烯类不敏感的细菌有26株,行MHT有11株阳性,MBL试验有8株阳性。经PCR扩增对阳性菌株进行基因检测,结果 3株携带KPC-2基因,5株携带NDM-1基因,1株携带IPM-4基因。ESBLs基因型中TEM型占60.1%(122/203)、CTX-M型占46.3%(94/203)、SHV型占15.8%(32/203),有39株细菌同时扩增出2种及以上基因型。结论海南地区泌尿系感染多重耐药肠杆菌科细菌主要以产ESBLs的大肠埃希菌和肺炎克雷伯菌为主,流行的基因型以TEM型多见,其次是CTX-M型和SHV型;已发现少量对碳青霉烯类不敏感菌株,其主要耐药机制为产生NDM-1、KPC-2、IPM-4基因,临床上应引起重视,严格做好预防和控制工作。Objective To investigate the epidemic characteristics of urinary system infection of multidrug-resistant enterobacteriaceae and its resistance mechanisms in Hainan District. Methods A total of 225 multidrug-resistant enterobacteriaceae isolated from midstream urine specimens in outpatients and inpatients from January 2012 to August 2013 in Hainan District. An identification of bacteria and drug sensitive test were carried out with VITEK 2 compact microbial ananlyzers,extended-spectrum β-lactamases（ ESBLs） by confirmatory test, carbapenemase phenotype confirmation performed on carbapenems insensitive strains by modified Hodge test（ MHT） and metallo-β-lactamases（ MBL） test, ESBLs, KPC enzyme,IPM enzyme,NDM-1 genotypic testing performed on positive strains by PCR amplification and the amplified products sequenced. Results A total of 203 from 225 strains of multidrug-resistant enterobacteriaceae produced ESBLs（ 90. 2%）,including 163 strains of escherichia coli,32 strains of klebsiella pneumoniae,4 strains of klebsiella oxytoca,4 strains of proteus mirabilis,22 strains of others（ 9. 8%）. By drug sensitive test,there were 26 strains of carbapenems insensitive bacteria,11 strains were positive by MHT,8 were positive by MBL test. By genetic testing of PCR amplififcation,3 strains carried KPC-2gene,5 carried NDM-1 gene,1 carried IPM-4 gene. In ESBLs genotypes,TEM accounted for 60. 1%（ 122 /203）,CTX-M for 46. 3%（ 94 /203）,SHV for 15. 8%（ 32 /203）. 39 strains amplified 2 or more genotypes at the same time. ConclusionIn Hainan District, multidrug-resistant enterobacteriaceae in urinary tracts are mainly escherichia coli and klebsiella pneumoniae producing ESBLs,their epidemic genotypes are mainly TEM,followed by CTX-M and SHV. We have found a small amount of carbapenem-insensitive strains,their main resistance mechanisms are producing NDM-1,KPC-2 and IPM-4 genes,which should be paid attention to.

关 键 词：泌尿系疾病 肠杆菌科感染 分子流行病学 

分 类 号：R69[医药卫生—泌尿科学]