我国2013-2014年肠杆菌科细菌中blaNDM-1基因流行病学特征  

Epidemiological characteristics of blaNDM-1 gene in Enterobacteriaceae strains circulating in China during 2013 to 2014

作　　者：王珊[1] 李耘[1] 薛峰[1] 刘健[1] 张佳[1] 宋运佳[1] 徐丹[1] 吕媛[1] Wang Shah Li Yun Xue Feng Liu Jian Zhang Jia Song Yunjia Xu Dan Lyu Yuan(Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, China)

机构地区：[1]北京大学第一医院临床药理研究所,100191

出　　处：《中华微生物学和免疫学杂志》2017年第2期125-131,共7页Chinese Journal of Microbiology and Immunology

基　　金：北京大学第一医院科研基金（2016QN14）

摘　　要：目的 了解我国2013—2014年肠杆菌科细菌中blaNDM-1基因的流行病学特征.方法由中国细菌耐药监测研究从全国19家三甲医院收集2577株肠杆菌科细菌.采用PCR方法筛查肠杆菌科细菌中含blaNDM-1基因的菌株.blaNDM-1基因阳性的菌株用API细菌鉴定系统及16S rRNA基因测序进行细菌种属鉴定,并用琼脂二倍稀释法测定抗菌药物的最低抑菌浓度（MIC）.用多位点序列测定及脉冲场凝胶电泳检测菌株的同源性.结果在2577株肠杆菌科细菌中筛选出来自8个不同省市的24株blaNDM-1基因阳性菌,分别为11株肺炎克雷伯菌,4株阴沟肠杆菌,3株雷氏普罗维登斯菌,2株大肠埃希菌,2株弗劳地枸橼酸杆菌,1株产酸克雷伯菌和1株粘质沙雷菌,均为多重耐药菌.肺炎克雷伯菌的主要序列型分别为ST17（5株,45.45%）和ST20（3株,27.27%）,且两者分别具有相似的克隆型.PFGE显示来自南京的3株雷氏普罗维登斯菌为同一克隆株.结论2013—2014年肠杆菌科细菌中blaNDM-1基因的检出率为0.93%,与2009—2010年（0%）、2011—2012年（0.32%）结果相比显著升高.其中1株细菌为国内第1株检测到blaNDM-1基因的粘质沙雷菌.本研究产NDM-1细菌多重耐药严重,产NDM-1的肺炎克雷伯菌占主要地位（45.83%）,且有暴发流行趋势,值得重视.Objective To investigate the epidemiological characteristics of blaNDM-1 gene （ enco-ding New Delhi metallo-β-lactamase 1） in Enterobacteriaceae strains circulating in China during July 2013 to June 2014. Methods A total of 2577 Enterobacteriaceae strains were collected from 19 Class A tertiary hospitals nationwide by China Antimicrobial Resistance Surveillance Trial （ CARST） . PCR was used to de-tect the presence of blaNDM-1 gene in those Enterobacteriaceae strains. For blaNDM-1-positive strains, Analytical Profile Index （API） strips and 16S rRNA analysis were used to identify bacterial genus and species. Antibi-otic susceptibilities were assessed by detecting minimum inhibitory concentrations （ MIC） against them with two-fold agar dilution test. Multilocus-sequence typing （ MLST ） and pulsed field gel electrophoresis （ PFGE） were performed for homology analysis. Results Among the 2577 strains, 24 from 8 different provinces and cities carried the blaNDM-1 gene, including 11 Klebsiella pneumoniae strains, 4 Enterobacter clo-acae strains, 3 Providencia rettgeri strains, 2 Escherichia coli strains, 2 Citrobacter freundii strains, 1 Kleb-sielia Oxytoca and 1 Serratia marcescens, and all of them were multidrug-resistant （MDR）. ST17 （5, 45. 45%） and ST20 （3, 27. 27%） were the predominant sequence types of Klebsiella pneumoniae strains. Strains of the same STs were clonally related. PFGE analysis showed that 3 Providencia rettgeri strains isola-ted in Nanjing belonged to the same clone. Conclusion The positive rate of blaNDM-1 gene in Enterobacteri-aceae strains isolated during 2013 to 2014 is 0. 93%, indicating a significant increase as compared with that during 2009 to 2010 （0%） and 2011 to 2012 （0. 32%）. The present study first reports the strain of Serra-tia marcescens harboring NDM-1 gene in China. NDM-1-producing strains are highly resistant to multiple drugs. Most of the NDM-1-producing Enterobacteriaceae strains were Klebsiella pneumoniae strains （45. 83%） warran

关 键 词：β-内酰胺酶NDM-1 肠杆菌科细菌 流行病学 BETA-LACTAMASE NDM-1 

分 类 号：R440[医药卫生—诊断学]