165株黏质沙雷菌耐碳青霉烯类基因检测与克隆型分析  

Clinical detection of gene and clonotype in 165 strains of carbapenem resistant Serratia marcescens

作　　者：侯沪 李爱敏 唐曙明 

机构地区：[1]深圳市人民医院龙华分院,广东深圳518000

出　　处：《现代预防医学》2015年第21期3955-3958,共4页Modern Preventive Medicine

摘　　要：目的研究临床分离耐碳青霉烯类黏质沙雷菌株的耐药基因及其克隆型,探讨黏质沙雷菌耐药流行特点与预防治疗对策。方法收集2013-2014年从本医院不同病区分离的耐碳青霉烯类黏质沙雷菌165株,以Vitek 2 compact检测其药敏结果,以PCR检测其耐碳青霉烯酶类基因,ERIC-PCR分析菌株的克隆型。结果耐碳青霉烯类黏质沙雷菌主要分离自重症监护室,其对氨曲南、头孢曲松、厄他培南与亚胺培南100%耐药;对左旋氧氟沙星、阿米卡星、复方新诺明、头孢吡肟、头孢他啶耐药率较低,分别为3.8%、4.4%、8.2%、19.0%和21.5%。PCR共检出常见碳青霉烯酶基因87株,其中36株携带bla SME基因,24株携带bla KPC基因,14株同时携带bla KPC和bla SME基因,13株携带bla NDM-1基因。165株可分为5类克隆型,Ⅰ类克隆型63株,Ⅱ类克隆型46株,Ⅲ类克隆型31株,Ⅳ类克隆型13株,Ⅴ类克隆型12株。结论耐碳青霉烯黏质沙雷菌的耐药机制复杂,以产A类碳青霉烯酶为主。同种克隆型趋于集中,容易引发区域医院感染暴发流行。合理应用抗菌药物,降低抗生素选择压力有利于控制耐碳青霉烯类菌株的蔓延。Objective To study the antimicrobial resistant gene and clonotype of clinical sequential isolates of carbapenem resistant Serratia marcescens, investigate the primary antimicrobial resistant popularity, prevention and treatment measures of Serratia marcescens. Methods We reviewed the antimicrobial resistance data of 165 carbapenem resistant Serratia marcescens isolates collected sequentially from different clinical wards during 2013 to 2014 in our hospital, to test the drug susceptibility results by Vitesk 2 compact. The antimicrobial resistant genes of carbapenems was detected by PCR, and the clonotype was analyzed by ERIC-PCR. Results The carbapenem resistant Serratia marcescens were mainly isolated from ICU in our hospital, and their resistant rates to aztreonam, ceftriaxone, ertapenem and imipenem were 100%. But their resistant rates of levofloxacin, amikacin,cotrimoxazole, cefepime and ceftazidime were 3.8%, 4.4%, 8.2%, 19.0%, 21.5%, respectively. The common carbapenemase genes were detected in 87 Serratia marcescens strains by PCR, including 36 strains carried bla SME gene. 24 strains carried bla KPC gene;14 strains carried simultaneously bla KPC and bla SME gene; 13 strains carried bla NDM-1 gene. 165 carbapenem resistant Serratia marcescens strains were probably divided into 5 classes of clonotype, including 63 stains of Ⅰ clonotype, 46 stains of Ⅱ clonotype,31 stains of Ⅲ clonotype, 13 stains of Ⅳ clonotype and 12 stains of Ⅴ clonotype. Conclusion The resistant mechanism of carbapenem resistant Serratia marcescens was complicated, and the most important mechanism was to produce A class carbapenemase. The same clonotype tends to be concentrated, easy to cause regional hospital infection outbreak. Rational use of antibacterial drugs and reducing antibiotic selection pressure are helpful to control the spread of penicillium carbon alkene resistant strains.

关 键 词：黏质沙雷菌 碳青霉烯类 克隆型 耐药基因 

分 类 号：R117[医药卫生—公共卫生与预防医学]