携带bla_(NDM-1)碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究  

Drug resistance mechanism of carbapenem resistant Providencia rettgeri carrying bla_(NDM-1)

作　　者：李巍 艾芙琪[2] 马逸珉[2] 王蓓[2] 田月如[2] LI Wei;AI Fuqi;MA Yimin;WANG Bei;TIAN Yueru(Department of Clinical Laboratory,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Clinical Laboratory,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属儿科医院临床检验中心,上海201102 [2]复旦大学附属华山医院检验科,上海200040

出　　处：《检验医学》2019年第1期67-70,共4页Laboratory Medicine

基　　金：上海青年临床医技人才计划(沪医卫基[2016]04号)

摘　　要：目的研究碳青霉烯类耐药雷极普罗威登斯菌的耐药表型、耐药机制、传播方式及同源性。方法对分离自重症监护病房(ICU)的17株雷极普罗威登斯菌进行药物敏感性试验、耐药基因筛选、NP试验、脉冲场凝胶电泳(PFGE)、质粒可移动性及复制子分型分析。结果 17株雷极普罗威登斯菌均携带碳青霉烯类耐药基因bla_(NDM-1)。对厄他培南、美罗培南、亚胺培南、头孢唑林、头孢呋辛、头孢噻肟、头孢吡肟、头孢美唑、哌拉西林、甲氧苄啶-磺胺甲噁唑、阿米卡星、庆大霉素、妥布霉素、卡那霉素、环丙沙星、呋喃妥因的耐药率为100.00%,对哌拉西林-他唑巴坦、氨曲南的耐药率为88.23%。PFGE同源性分析显示17株雷极普罗威登斯菌中有15株为ICU主要流行株;质粒分析显示bla_(NDM-1)存在于～160 kb接合性质粒上,复制子Inc分型为A/C型,质粒携带多种耐药基因,除对环丙沙星和呋喃妥因敏感外,介导对碳青霉烯类、头孢类、头霉素类、磺胺类和氨基糖苷类抗菌药物高水平耐药。结论携带bla_(NDM-1)的雷极普罗威登斯菌多重耐药,临床抗感染治疗难度较大。Objective To investigate the phenotype,mechanism,disseminative way and homology of carbapenem resistant Providencia rettgeri.Methods A total of 17 isolates of Providencia rettgeri isolated from intensive care unit(ICU)were collected,and antibiotic susceptibility test,drug resistance gene detection,NP test,pulsed-field gel electrophoresis(PFGE),plasmid mobility analysis and replicon typing were performed.Results The 17 isolates of carbapenem resistant Providencia rettgeri carried blaNDM-1.The drug resistance rates to ertapenem,meropenem,imipenem,cefazolin,cefuroxime,cefotaxime,cefepime,cefmetazole,piperacillin,trimethoprim-sulfamethoxazole,amikacin,gentamicin,tobramycin,kanamycin,ciprofloxacin and furadantin were 100.00%.The drug resistance rates to piperacillin-tazobactam and aztreonam were 88.23%.PFGE homology analysis showed that 15 isolates were the main epidemic isolates in ICU.Plasmid analysis showed that the blaNDM-1 were located on conjugative plasmid(-160 kb),and replicon type was type A/C.Plasmid carried a variety of drug resistance genes,being sensitive to ciprofloxacin and furadantin,and it mediated the high-level drug resistance to carbapenems,cephalosporins,cephamycins,sulfonamides and aminoglycosides.Conclusions Providencia rettgeri carrying blaNDM-1 shows multi-drug resistance to common antibiotics,and it brings challenge to clinical antiinfection treatment.

关 键 词：雷极普罗威登斯菌 碳青霉烯类耐药 BLA NDM-1基因 耐药机制 重症监护病房 

分 类 号：R378.99[医药卫生—病原生物学]