神经外科重症监护室患者感染碳青霉烯酶类耐药黏质沙雷菌的分子流行病学研究  

Molecular epidemiology study on carbapenem-resistant Serratia marcescens strains in patients in intensive care unit of neurosurgery

作　　者：马金龙[1,2] 刘真真 李笃军 贾楠 王云[2] 朱元祺[1,2] MA Jin-long;LIU Zhen-zhen;LI Du-jun;JIA Nan;WANG Yun;ZHU Yuan-qi(The Affiliated Hospital of Qingdao University,Qingdao,Shandong 266555,China;不详)

机构地区：[1]青岛大学附属医院检验科,山东青岛266555 [2]青岛大学医学院,山东青岛266071 [3]山东省烟台业达医院检验科,山东烟台264006

出　　处：《中华医院感染学杂志》2020年第3期393-397,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81802107);烟台市科技计划基金资助项目(2019MSGY132);烟台业达医院科技发展基金资助项目(2018-1-82)。

摘　　要：目的研究神经外科重症监护室患者感染碳青霉烯类抗菌药物耐药黏质沙雷菌的耐药机制和流行病学。方法选择2014年10月-2015年3月青岛大学附属医院分离自神经外科重症监护室患者的6株黏质沙雷菌进行鉴定和药敏试验;采用聚合酶链反应(PCR)扩增和产物测序确认菌株携带的耐药基因;脉冲场凝胶电泳和质粒接合试验分析菌株的同源性和质粒转移特性。结果6株黏质沙雷菌药敏表型和基因型一致,对头孢曲松、氨曲南、厄他培南、亚胺培南和美罗培南耐药;每一株菌都携带blaKPC-2、blaSRT-1、aac(6’)-Ic和fosA7耐药基因;6株菌的脉冲场凝胶电泳带型完全相同,并可将携带blaKPC-2基因的质粒成功转移到大肠埃希菌J53AziR。结论携带blaKPC-2、blaSRT-1、aac(6’)-Ic和fosA7耐药基因黏质沙雷菌的克隆播散是神经外科重症监护室患者医院感染的原因。OBJECTIVE To investigate the molecular mechanisms and epidemiology of carbapenem-resistant Serratia marcescens strains in patients in intensive care unit of neurosurgery.METHODS Six S.marcescens strains isolated from the clinical sputum culture were selected for identification and susceptibility testing from Oct.2014 to Mar.2015 in the Affiliated Hospital of Qingdao University.The drug resistance genes carried by the strains were confirmed by polymerase chain reaction(PCR)amplification and product sequencing.The homology and plasmid transfer characteristics of the strains were analyzed by the pulsed field gel electrophoresis and plasmid conjugation assay.RESULTS Phenotypic and genotypic profiles of 6 S.marcescens strains were consistent and were resistant to ceftriaxone,aztreonam,ertapenem,imipenem as well as meropenem.Each strains carried blaKPC-2,blaSRT-1,aac(6’)-Ic and fosA7 resistance genes.The pulsed-field gel electrophoresis(PFGE)bands of six strains were identical,and the plasmid carrying the blaKPC-2 gene was successfully transferred to E.coli J53 AziR.CONCLUSIONS Our results showed that the cloning spread of S.marcescens carrying blaKPC-2,blaSRT-1,aac(6’)-Ic and fosA7 resistance genes is the cause of nosocomial infection in patients inintensive care unit of neurosurgery department.

关 键 词：黏质沙雷菌 blaKPC-2 神经外科重症监护室 分子流行病学 碳青霉烯类耐药性 

分 类 号：R378[医药卫生—病原生物学]