耐碳青霉烯类肠杆菌科细菌对喹诺酮类耐药机制的研究  

Mechanisms of quinolone resistance of carbapenem-resistant Enterobacteriaceae

作　　者：苏珊珊 张吉生[1] 王英[1] 王勇[1] 王宇超[1] 李慧玲[1] 张晓丽[1] SU Shan-shan;ZHANG Ji-sheng;WANG Ying;WANG Yong;WANG Yu-chao;LI Hui-ling;ZHANG Xiao-li(Department of Laboratory Medicine, First Affiliated Hospital of Jiamusi University, Jiamusi 154007, China)

机构地区：[1]佳木斯大学附属第一医院检验科,黑龙江佳木斯154007

出　　处：《中国感染控制杂志》2019年第2期99-104,共6页Chinese Journal of Infection Control

基　　金：黑龙江省自然科学基金(D201224);黑龙江省卫生计生委科研项目(2017-405);佳木斯大学学科交叉项目(12J201505)

摘　　要：目的研究质粒介导喹诺酮耐药(PMQR)基因在耐碳青霉烯类肠杆菌(CRE)中的流行情况及耐药机制。方法收集2015年3月—2018年3月某院临床分离的CRE菌株,VITEK2 Compact分析仪对其进行鉴定及药物敏感试验,采用聚合酶链反应(PCR)及测序确定PMQR基因qnrA、qnrB、qnrS、qepA、acc(6’)Ib-cr携带情况,通过质粒接合试验验证PMQR基因的水平转移。结果耐碳青霉烯类大肠埃希菌对喹诺酮类药物的耐药率达100%,耐碳青霉烯类肺炎克雷伯菌对喹诺酮类药物的耐药率为15.56%～33.33%。acc(6’)Ib-cr基因检出率最高(87.72%),其次为qnrB(77.19%)和qnrS(17.54%),有2株菌携带qnrA基因(3.51%),未分离出qepA基因,菌株同时含有2种或3种PMQR基因(84.21%)。8株接合成功的菌株均存在PMQR基因转入,但喹诺酮药物对其最低抑菌浓度无明显改变。结论虽然该院CRE质粒介导喹诺酮耐药基因检出率高,但对喹诺酮类药物仍存在一定敏感性。Objective To study the prevalence of plasmid-mediated quinolone resistance(PMQR)genes in carbapenem-resistant Enterobacteriaceae(CRE)and its resistance mechanism.Methods Clinically isolated CRE strains in a hospital from March 2015 to March 2018 were collected,then identified and performed antimicrobial susceptibility test by VITEK 2 Compact analyzer,carriage of PMQR genes qnr A,qnr B,qnr S,qep A and acc(6’)Ib-cr were determined by polymerase chain reaction(PCR)and sequencing,the horizontal transfer of PMQR genes were verified by plasmid conjugation test.Results Resistance rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae to quinolones were 100%and 15.56%-33.33%respectively.Detection rate of acc(6’)Ib-cr gene was the highest(87.72%),followed by qnr B(77.19%)and qnr S(17.54%),2 strains(3.51%)carried qnr A gene,qep A gene was not isolated,84.21%of strains harbored 2 or 3 PMQR genes.PMQR gene was transfected into all the 8 conjugated strains,but minimum inhibitory concentration value of quinolones didn’t change significantly.Conclusion The detection rate of PMQR genes in CRE in this hospital is high,but there is a certain sensitivity to quinolones.

关 键 词：喹诺酮耐药基因 肠杆菌科细菌 耐碳青霉烯类肠杆菌 耐药性 

分 类 号：R378.2[医药卫生—病原生物学]