耐碳青霉烯类肠杆菌科细菌的现状研究  

Research on the current situation of the carbapenems-resistant Enterobacteriaceae

作　　者：胡继华 梁振刚[2] 郭主声[2] 周谋清 张丽[2] HU Ji-hua LIANG Zhen-gang GAUO Zhu-Sheng ZHOU Mou-qing ZHANG(Futian District Shenzhen Hospital of Traditional Chinese Medicine Shenzhen, Guangdong 518032, China)

机构地区：[1]深圳市福田区中医院感染管理科,广东深圳518032 [2]中山大学附属东莞东华医院微生物实验室,广东东莞523001

出　　处：《中华医院感染学杂志》2017年第4期725-728,共4页Chinese Journal of Nosocomiology

基　　金：中华医院感染基金资助项目(ZHYY2015-0015)

摘　　要：目的了解东莞地区耐碳青霉烯类肠杆菌科细菌(CRE)检出率、感染状况及其耐药基因情况。方法收集2015年1月-2016年3月东莞地区细菌耐药监测CRE阳性菌株和相关临床资料,重新进行菌种的鉴定及相应药敏结果的复核,阳性者则采用改良Hodge试验进行碳青霉烯酶表型确证试验,复核确定的CRE菌种采用聚合酶链反应法检测细菌携带的耐药基因。结果 2015年1月-2016年3月共检出肠杆菌菌株16 182株,其中CRE 45株,检出率0.28%;肺炎克雷伯菌中分离出CRE 17株,检出0.44%;大肠埃希菌中分离出CRE7株,检出率0.08%;阴沟肠杆菌中分离出CRE13株,检出率1.84%;其余分离8株,检出率0.27%,大肠埃希菌中CRE检出率总体较低;痰液、胆汁中CRE检出率分别为0.49%、1.27%,与CRE总体检出率相比差异有统计学意义(P<0.05);45株CRE药敏分析显示,亚胺培南耐药率100%,美罗培南耐药率82.22%。耐药率低于30%的药物仅有阿米卡星(15.56%),耐药率低于40.00%只有妥布霉素(31.11%),耐药率在40.00%~50.00%药物仅有磺胺甲噁唑/甲氧苄啶,而临床广泛使用的氟喹诺酮类、派拉西林/他唑巴坦等药物耐药率超过50.00%,三代头孢及其含酶抑制剂超过70.00%;送微生物实验室鉴定的7株CRE碳青霉烯酶基因扩增均为阳性,IMP-4阳性1例,NDM-6阳性6例,1例为NDM-6与CTX多基因阳性携带共存。结论东莞地区CRE检出率不高,本地区首次检测到NDM-6耐药基因,在国内其他地区也是少见,且与前几年耐药基因比较有了较大变迁,应全面加强抗菌药物的监管,重视医院感染防控措施的落实。OBJECTIVE To understand the detection rate drug resistance and resistant genes of the carbapenems-resistant Enterobacteriaceae（CRE）.METHODS CRE positive strains and related clinical data were collected from the medical unit of bacterial resistance monitoring in Dongguan area from Jan.2015 to Mar.2016.Strains were identified by VITEK-2-Compact and corresponding drug sensitivity results were reviewed.The positive strains in the preliminary screening were conducted with modified Hodge test to verify the phenotype of the carbapenems.The polymerase chain reaction was adopted to detect the resistant genes carried by the bacteria among the re-checked CRE strains.RESULTS Totally 45 cases of CRE were detected,with the overall detection rate of 0.28%（45/13137strains）.The detection rate of Klebsiella pneumoniae was 0.44%（17/3881strains）,that of Escherichia coli was0.08%（7/8599strains）,that of Enterobacter cloacae was 1.84%（13/694strains）,and that of other enteric bacilli was 0.27%（8/2963strains）.The detection rate of CRE in Escherichia coli was low.The CRE isolation rates of sputum and bile were respectively 0.49%（18/3684strains）and 1.27%（3/237strains）,which had significant difference with the overall detection rate of CRE（P〈0.05）.The drug sensitivity analysis of 45 strains of CRE showed that imipenem resistant rate was 100%,and meropenem resistant rate was 82.22%.Only amikacin resistant rate was lower than 30.00%（15.56%）,tobramycin resistant rate was lower than 40.00%（31.11%）,and sulfamethoxazole/trimethoprim resistant rate was 40.00%~50.00%.The drug resistant rates to widely used fluoroquinolones and praziquantel/tazobactam were more than 50.00%,and to the third generation of cephalosporin and its enzyme inhibitor were more than 70.00%.The 7strains of CRE carbapenemase gene amplification sent to be identified by microbiological laboratory were positive,among which 1case was IMP-4positive,6cases were NDM-6positive,and 1case had co-existence of NDM-6and CTX multi-gene positive.C

关 键 词：耐碳青霉烯类 肠杆菌科 东莞地区 耐药基因检测 

分 类 号：R378.2[医药卫生—病原生物学]