肠杆菌科细菌耐药性的变迁及碳青霉烯酶基因型分析  

Diversify of drug resistance and analysis of genotypes of carbapenemase in Enterobacteriaceae

作　　者：纪明宇[1] 耿大影[2] 吴洪巧[3] 裴凤艳[1] 

机构地区：[1]山东大学附属济南市中心医院医学实验诊断中心,济南250013 [2]济南市传染病医院检验科,济南250021 [3]山东大学附属济南市中心医院医院感染管理科,济南250013

出　　处：《中国临床药理学杂志》2016年第17期1577-1579,1594,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的分析2011-2015年临床分离的肠杆菌科细菌耐药性变迁及主要碳青霉烯酶基因型。方法以美国临床和实验室标准协会(CLSI)2015版为判定标准进行抗菌药物敏感性分析,筛选出亚胺培南或美罗培南耐药的肠杆菌科细菌(CRE)共39株,用PCR方法扩增常见碳青霉烯酶基因(bla_(KPC)、bla_(IMP)、bla_(VIM)、bla_(NDM)),并对PCR扩增产物进行测序比对分析。结果共收集4542株肠杆菌科细菌,位列前3位的分别是大肠埃希菌(44.8%)、肺炎克雷伯菌(24.8%)和阴沟肠杆菌(4.8%)。肠杆菌科细菌对碳青霉烯类耐药率最低(<7%),其次是阿米卡星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦菌(<20%)。产超广谱β内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为57.8%,38.3%。39株CRE以肺炎克雷伯菌(12/39)、阴沟肠杆菌(8/39)为主,有13株扩增出碳青霉烯酶基因,其中10株携带有bla_(KPC-2)基因,以肺炎克雷伯菌(5/10)为主;3株携带有bla_(IMP-4)基因。结论 5年间肠杆菌科细菌耐药率变化趋势不明显,CRE菌株有增加趋势,基因型以bla_(KPC-2)为主。Objective To study the diversity of drug resistance and main genotypes of carbapenemase in Enterobacteriaceae from 2011 to 2015. Methods Results were analyzed retrospectively according to Clinical and Laboratory Standards Institute（CLSI） 2015 standards. A total of 39 strains of carbapenem - resistant Enterobacteriaeeae （ CRE ） isolates with resistance to imipenem or meropenem were collected in our hospital. PCR method was used to screen for the main carbapenemase genes （blaKPC, blalMP,blavIM ,blaNDM）. The product of PCR was sequenced and conduc- ted by Blast. Results A totle of 4542 isolates were analyzed. The isola- ted Escherichia coli strains accounted for 44. 8%, followed by KlebsieU pneumoniae 24. 8% and Enterobacter cloacae 4. 8%. The resistance rate of Enterobacteriaceae spp to carbapenems was the lowest, 〈7%, and followed by amikacin, piperacillin/tazobactam, cefoperazone/sulbactam was less than 20%. The ESBLs - producing E. coli and K. pneumoniae was 57. 8% , 38. 3%, respectively. Majority of the 39 CRE isolates were K. pneumortiae（12/39） and E. cloacae（8/39）. Among the 39 CRE strains, 10 strains were positive for blaKPC2. The dominant isolates was K. pneumoniae （5/10） and 3 strains were genotype blatMp_4 by Blast alignment. Conclusion During the resistance rates did not chang significantly in Enterobacteriaceae. The presence CRE showed an increasing tendency, BlaKPC-2 was the primary genotype among CRE.

关 键 词：肠杆菌科细菌 抗菌药物 耐药 碳青霉烯酶 

分 类 号：R978.1[医药卫生—药品]