35株vanA与vanM双基因型万古霉素耐药屎肠球菌株在重症监护病房的分布及传播特点  

Distribution and transmission characteristics of thirty-five dual genotype vancomycin-resistant Enterococcus faecium carrying both vanA and vanM in an intensive care unit

作　　者：袁轶群 丁丽 周迎 李培 林东昉 丁柳美 徐晓刚 Yuan Yiqun;Ding Li;Zhou Ying;Li Pei;Lin Dongfang;Ding Liumei;Xu Xiaogang(Department of Clinical Laboratory,Jinshan Hospital,Fudan University,Shanghai 201508,China;Institute of Antibiotics,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属金山医院检验科,上海201508 [2]复旦大学附属华山医院抗生素研究所,上海200040

出　　处：《中华传染病杂志》2019年第8期483-487,共5页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金(81171613)。

摘　　要：目的了解vanA与vanM双基因型万古霉素耐药屎肠球菌(vancomycin-resistant Enterococcus faecium,VREF)在重症监护病房的分布及传播特点。方法收集2013年至2017年复旦大学附属金山医院重症监护病房分离到的VREF菌株共35株,采用微量肉汤稀释法测定菌株对万古霉素、替考拉宁、利奈唑胺和氯霉素等9种抗菌药物的敏感性。采用多重聚合酶链反应(polymerase chain reaction,PCR)进行van基因分型,并通过脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)进行菌株同源性分析。结果35株耐药菌株标本主要分离自尿液16株、血液11株、粪便5株、胆汁2株和胸腔积液1株。所有菌株对万古霉素、氨苄西林、左氧氟沙星耐药率均为100.00%,对替考拉宁耐药率为40.00%,所有菌株均对利奈唑胺敏感。van基因分型结果显示,33株(94.3%)属vanA和vanM双基因型VREF,其余2株为vanA型VREF。PFGE结果显示,35株可分为14个PFGE谱型,其中10株2014年分离的菌株中有7株谱型相同,其余3株分属3个不同PFGE谱型。结论一种同时携带vanA和vanM的双基因型VREF已在金山医院重症监护病房出现并持续传播。Objective To investigate the distribution and transmission characteristics of vancomycin-resistant Enterococcus faecium(VREF)carrying both vanA and vanM in the intensive care unit.Methods VREF strains were isolated from patients in the intensive care unit of Jinshan Hospital,Fudan University in Shanghai from 2013 to 2017.Antimicrobial susceptibilities of the VREF strains to nine antibiotics,including vancomycin,teicoplanin,linezolid and chloromycetin,were tested by broth microdilution method.Multiple polymerase chain reaction(PCR)was used for van genotyping and pulsed field gel electrophoresis(PFGE)was used for homology analysis.Results Thirty-five strains were mainly isolated from urine(16 strains),blood(11 strains),feces(five strains),bile(two strains)and pleural effusion(one strain).All the strains(100.00%)were resistant to vancomycin,ampicillin and levofloxacin,but only 40.00%were resistant to teicoplanin.All the strains were sensitive to linezolid.The results of van genotyping showed that 33(94.3%)strains belonged to vanA and vanM dual genotype VREF,and the other two were vanA type VREF.PFGE results showed that 35 strains could be divided into 14 PFGE patterns,and seven out of 10 strains isolated in 2014 were identical and the other three belonged to three different PFGE patterns.Conclusions A dual genotype VREF carrying both vanA and vanM has been emerging and spreading in the intensive care unit of Jinshan Hospital,Fudan University in Shanghai.

关 键 词：肠球菌 屎 万古霉素 抗药性 基因 基因型 

分 类 号：R44[医药卫生—诊断学]