浙江省丽水地区产KPC型碳青霉烯酶细菌的分布和耐药性分析  

Distribution and drug resistance of KPC carbapenemase-producing bacteria isolated in Lishui area,Zhejiang province

作　　者：余璟璐[1] 江丽莉[1] 李爱芳[1] 丁茂文[1] 赵志钢[1] 

机构地区：[1]丽水市中心医院检验科,浙江丽水323000

出　　处：《中华医院感染学杂志》2017年第1期12-15,共4页Chinese Journal of Nosocomiology

基　　金：丽水市科学技术局科技项目(2014JYB23)

摘　　要：目的了解浙江省丽水地区产KPC型碳青霉烯酶细菌情况,为控制医院感染和临床合理用药提供依据。方法收集医院2015年1月-2016年7月送检微生物培养阳性的肠杆菌科细菌2 800株;采用法国生物梅里埃全自动细菌鉴定仪VITEK-2Compact进行病原菌检测,采用K-B法和GN-13药敏卡进行菌株筛选,对厄他培南和美罗培南中度敏感和耐药的菌株作为待测菌,进行改良Hodge试验;聚合酶链反应(PCR)法检测KPC酶基因型,E-test法检测替加环素对产KPC型碳青霉烯酶细菌的体外抗菌活性。结果 2 800株待测菌中筛选出80株耐碳青霉烯类肠杆菌属(CRE),经改良Hodge试验检测,有61株阳性,阳性率为2.2%,以肺炎克雷伯菌为主,占73.7%;61株CRE菌株对米诺环素、磷霉素、阿米卡星等耐药率分别为19.6%、30.0%、21.4%,对多黏菌素B耐药率为0,对其他抗菌药物的耐药率均较高;26株非痰液标本均扩增出KPC-2型目的基因条带。结论产KPC型碳青霉烯酶细菌已经在本地区普遍流行,应加强细菌耐药性监测并合理使用抗菌药物。OBJECTIVE To investigate the KPC carbapenemase-producing bactei：ia isolated in Lishui area, Zhejiang province so as to provide guidance for control of nosocomial infections and reasonable clinical use of antibiotics. METHODS From Jan 2015 to Jul 2016. a total of 2 800 strains of Enterobacteriaceae that were submitted and posi- tive for microbial culture were collected, the pathogens were detected by using automatic bacterial identification system VITEK-2 Compact of bioM^rieux, France, the strains were screened out by means of K-B method and GN- 13 card. The strains that were moderately susceptible or meropenem were chosen as the test strains, the modified Hodge test was carried out, the KPC enzyme genotypes were detected via polymerase-chain-reaction （PCR）, and the in vitro antibacterial activity of tigecycline against the KPC earbapenemase-producing bacteria was tested by means of E-test. RESULTS Totally 80 strains of carbapenem-resistant Enterobacter （CRE） were screened out from the 2 800 test strains, the modified Hodge test showed that 61 strains were positive, with the positive rate 2.2% Klebsiella pneumoniae was dominant, accounting for 73.7 %. The drug resistance rates of the 61 strains of CRE to minocycline, fosfomycin, and amikaein were 19.6%, 30.0%, and 21.4%, respectively; the drug resistance rate to polymyxin B was 0, while the drug resistance rates to other antibiotics were relatively high. KPC-2 target gene band was amplified from 26 strains that were isolated from non-sputum specimens. CONCLUSION The KPC car- bapenemase-producing bacteria have been prevalent in this area, and it is necessary to strengthen the monitoring of bacterial drug resistance and reasonably use antibiotics.

关 键 词：肠杆菌科细菌 耐药性 耐碳青霉烯类肠杆菌属 KPC 

分 类 号：R378.2[医药卫生—病原生物学]