腹腔感染肠杆菌科细菌的菌群分布及分子生物学分析  

Distribution and molecular biology analysis of enterobacteriaceae in intra-abdominal infections

作　　者：吴多荣[1] 黄会[1] 佘姝敏 黄增光[2] 

机构地区：[1]海口市人民医院,海南海口571500 [2]广州医科大学附属第一医院,广东广州510120

出　　处：《现代预防医学》2015年第19期3568-3571,共4页Modern Preventive Medicine

基　　金：海口市重点科技计划项目(编号:2012-070)

摘　　要：目的探讨腹腔感染肠杆菌科细菌的菌群分布及产碳青霉烯酶现状。方法收集该院2012年1月-2013年12月腹腔感染的肠杆菌科细菌157株,用VITEK 2 compact分析仪进行细菌鉴定和药敏试验,采用改良Hodge试验和双纸片增效试验分别进行碳青霉烯酶和金属酶表型确认,设计通用引物行PCR检测KPC、NDM-1、IMP、VIM、SME、OXA-23和NMC 7种基因。结果 157株肠杆菌科细菌中大肠埃希菌84株(占53.5%)、肺炎克雷伯菌47株(占29.9%)、阴沟肠杆菌8株(5.1%),其他肠杆菌18株(占11.5%)。药敏显示亚胺培南、美洛培南和阿米卡星对肠杆菌科细菌具有较好的抗菌活性,敏感率均高于95%;除头孢呋辛、头孢噻肟和复方新诺明的耐药率稍高外,其余9种抗菌药物的耐药率均低于40%。大肠埃希菌和肺炎克雷伯菌产ESBLS的发生率为52.4%和29.8%,产ESBLS大肠埃希菌对12种抗菌药物的耐药率明显高于非产ESBLS株(P<0.05)。发现6株对碳青霉烯类不敏感的细菌,经PCR检测,结果有一株肺炎克雷伯菌携带KPC-2基因。结论该院腹腔感染的肠杆菌科细菌主要以大肠埃希菌和肺炎克雷伯菌为主,感染类型以胆道感染多见,发现有KPC-2型碳青霉烯酶的流行传播。Objective To explore the distribution of enterobacteriaceae in intra-abdominal infections as well as the status of carbapenemases. Methods We conducted identification and susceptibility tests by the analyzer of VITEK2 compac to the 157 enterobacteriaceae in intra-abdominal infections collected from the hospital from the January of 2012 to the December of 2013. We conducted the phenotype identification of metallo-beta-lactamases （MBL） and carbapenemases by the modified hodge test （MHT） and double disc synergy test. With the designed general primers, KPC, NDM-1, IMP, VIM, SME, OXA-23 and NMC genes were detected by PCR. Results Among 157 Enterobacteriaceaes, escherichia coli （E. coli）, klebsiella pneumonia （KPN）, enterobacter cloacae and other enterobacters were 84 （53.5%）, 47 （29.9%）, 8 （5.1%） and 18 （11.5%） respectively. The antibacterial activities of imipenem, meropenem and amikacin to enterobacteriaceae were much better, and all the susceptibilities of them were above 95%. Except cefuroxime, cefotaxime and smzco with higher resistance rates, the resistance rates of other 9 kinds of antibacterials were lower than 40%. The rates of producing ESBLs in E. coli and KPN were 52. 4% and 29. 8% respectively, and E. coli which produced ESBLs had a higher resistance rate to 12 kinds of antibacterials than others which didn＇t produce ESBLs （P〈0.05）. There were 6 strains which were insensitive to carbapenems, and among them, there was one strain of KPN with KPC-2 gene after the PCR test. Conclusion E. coli and KPN are the main enterobacteriaceaes in intra-abdominal infections, and the common type of infection is biliary tract infection. Also we find there has a spread of carbapenemases with KPC-2 gene.

关 键 词：腹腔感染 肠杆菌科细菌 菌群分布 分子生物学 

分 类 号：R113[医药卫生—公共卫生与预防医学]