武汉地区耐碳青霉烯类肠杆菌科细菌耐药基因的研究  

Carbapenem-resistant Enterobacteriaceae resistant gene in Wuhan

作　　者：杨勇文[1] 李从荣[1] 李珍[1] 潘月华[1] 冯丽娜[1] 陈浩俊[1] 郭静[1] Yang Yongwen;Li Congrong;Li Zhen;Pan Yuehua;Feng Lina;Chen Haojun;Guo Jing(Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China)

机构地区：[1]武汉大学人民医院检验科,武汉市430060

出　　处：《中华实验和临床感染病杂志（电子版）》2017年第4期352-358,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家临床重点专科项目编号(No.2010305)

摘　　要：目的探讨武汉地区产碳青霉烯酶肠杆菌科细菌的主要耐药基因,并对耐碳青霉烯类的耐药机制进行初步分析。方法采用Carba NP试验对88株耐碳青霉烯类抗菌药物肠杆菌科细菌进行耐药表型确证。采用PCR方法检测KPC、NDM、VIM、IMP以及OXA-48共5种主要的碳青霉烯酶耐药基因并行测序验证。结果 88株临床分离菌对头孢唑林和氨苄西林耐药率均高达100.0%,对哌拉西林、氨苄西林/舒巴坦、阿莫西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、头孢噻肟、头孢吡肟和亚胺培南均>90.0%;Carba NP实验阳性菌株76株(86.4%),其中弱阳性11株;29株检出NDM-1耐药基因,24株携带KPC-2型碳青霉烯酶耐药基因,14株检出IMP-1型耐药基因,9株检出VIM-1型耐药基因,未检出OXA-48型耐药基因;4株联合产KPC和NDM基因肺炎克雷伯菌,2株联合产NDM和VIM基因阴沟肠杆菌。结论本地区肠杆菌科细菌对碳青霉烯类抗菌药物的耐药机制主要是携带NDM-1和KPC-2型碳青霉烯酶基因。Objective To investigate the major resistance gene product carbapenemases Enterobacteriaceae in Wuhan,and to analyze the mechanism of resistance to carbapenem-resistant preliminary.Method Caries NP test was used to confirm the resistant phenotype of88strains of carbapenemresistant antimicrobial agents Enterobacteriaceae.The KPC,NDM,VIM,IMP and OXA-48carbapenemase resistance genes were detected by PCR and then sequenced.Results Total of88clinical isolates of cefazolin and ampicillin resistance rates were all100.0%,while to piperacillin,ampicillin/sulbactam,amoxicillin/clavulanate,piperacillin/tazobactam,ceftazidime,cefotaxime,cefepime and imipenem were more than90.0%.Carba NP test positive strains of76strains(86.4%),among which,11strains were weakly positive.Twentyfour strains of NDM-1resistant gene were detected,24strains were resistant to KPC-2carbapenemase,14strains were detected including IMP-1resistance gene,9strains were detected including VIM-1resistance gene,OXA-48resistant gene was not detected.Four strains of Klebsiella pneumoniae combined with KPC and NDM genes,two strains of Enterobacter cloacae combined with NDM and VIM genes.Conclusions In Wuhan,Enterobacteriaceae carbapenem resistance mechanisms to antimicrobial agents mainly carrying NDM-1and KPC-2type carbapenem enzyme gene.

关 键 词：肠杆菌科细菌 碳青霉烯酶 耐药基因 

分 类 号：R446.5[医药卫生—诊断学]