两株泛耐药雷氏普罗威登斯菌耐药机制及临床感染特征研究  

The drug resistance mechanism and clinical infection characteristics of Providencia rettgeri with pan drug resistance

作　　者：俞凤[1] 胡龙华[1] 陈艳慧[1] 钟桥石[1] 杭亚平[1] 蒋沁炊 方雪瑶 许秀华 张楠[1] 胡晓彦[1] YU Feng;HU Longhua;CHEN Yanhui;ZHONG Qiaoshi;HANG Yaping;JIA Qinwen;FANG Xueyao;XU Xiuhua;ZHANG Nan;HU Xiaoyan(Clinical Laboratory of the Second Affiliated Hospital of Nanchang University,Key Laboratory of Jiangxi Province for Laboratory Medincine,Nanchang,Jiangxi 330006,Chin)

机构地区：[1]南昌大学第二附属医院检验科、江西省医学检验重点实验室,江西南昌330006

出　　处：《国际检验医学杂志》2018年第A01期97-101,共5页International Journal of Laboratory Medicine

摘　　要：目的 研究两株泛耐药雷氏普罗威登斯菌的耐药机制及其感染临床特征。 方法 收集2016年10-11月该院临床分离到的两株泛耐药雷氏普罗威登斯菌，采用Vitek 2 compact 进行菌种鉴定及药敏试验，用E-test法测定亚胺培南的MIC值，用改良碳青霉烯酶灭活试验（mCIM法）检测碳青霉烯酶；PCR扩增检测碳青霉烯酶、ESBLs、AmpC酶、喹诺酮类等19种耐药基因并测序确定基因型；采用接合实验和S1-PFGE分析质粒特征。 结果 两株实验菌株对检测的16种抗菌药物中仅菌株N339对替加环素敏感，对其他抗菌药物均耐药，mCIM试验阳性，两株雷氏普罗威登斯菌均同时携带blaNDM-1和blaPER-4基因，未检测到其他耐药基因，菌株N339接合成功，使结合子获得相似的耐药表型；S1-PFGE分析表明两株菌均含有两个相同大小（ 200~ 300 kb）的质粒。 结论 雷氏普罗威登斯菌质粒同时携带碳青霉烯酶基因NDM-1和超广谱β内酰胺PER-4基因是导致其广泛耐药的主要原因，且能通过质粒转移，应引起高度重视。首次发现雷氏普罗威登斯菌同时携带NDM-1和PER-4两种基因。Objective： To investigate the drug resistance mechanism and clinical features of two pan-resistant Providencia rettgeri strains. Methods Collecting from October 2016 to November 2016,two strains of pan-resistant P.rettgeri,vitek 2 compact identification and supporting drug susceptibility card were tested,the MIC value of imipenem was determined by E-test,carbapenem enzyme was detected by Modified Carbapenem Inactivation Method（mCIM）,extended spectrum betalactamases （ESBLs）,Ampc,carbapenemases and quinolones were amplified and sequenced by PCR,plasmid characteristics were analyzed using conjugation experiments and S1-PFGE. Results： The two isolates tested were sensitive for the 16 tested antimicrobial,but only N339 strain to to tigecycline sensitive,resistance to other antibiotics.these strains were positive by mCIM method.Two strains of P.rettgeri carry both blaNDM-1 and blaPER-4 genes,no resistance gene was detected,the strain N339 was successfully conjugation and obtain similar resistant genes,S1-PFGE analysis showed that both strains contained two plasmids of the same size （200-300 kb）. Conclusion ： The main reason that P.rettgeri plasmid carries both carbapenemase NDM-1 gene and extended-spectrum beta-lactam PER-4 gene is the main cause of its extensive resistance,and through the plasmid transfer,supervision department should pay attention.It was the first discovered that P.rettgeri isolates carry both NDM-1 and PER-4 genes.

关 键 词：雷氏普罗威登斯菌 NDM-1 PER-4 

分 类 号：R573.3[医药卫生—消化系统]