203株耐碳青霉烯类肠杆菌科细菌临床分布特征及耐药基因型分析  

Analysis of clinical distribution and drug resistance genotyping of 203 carbapenem enterobacteriaceae strains

作　　者：佘亚辉[1] 韩媛媛[1] 柴杰[1] 荣令[1] SHE Yahui;HAN Yuanyuan;CHAI Jie;RONG Ling(Department of Clinical Laboratory,People’s Hospital of Bozhou,Bozhou,Anhui 236800,China)

机构地区：[1]亳州市人民医院检验科,安徽亳州236800

出　　处：《安徽医药》2020年第5期885-888,共4页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金(81571528)。

摘　　要：目的探讨医院耐碳青霉烯类肠杆菌科细菌(CRE)的分布特征、耐药特点及耐药基因型,为临床CRE感染治疗提供理论依据。方法收集2016年1月至2018年9月亳州市人民医院临床分离的CRE菌株,应用Vitek 2 Compact全自动微生物分析仪对细菌进行鉴定和药敏试验。采用荧光定量PCR方法检测5种耐药基因KPC、IMP、VIM、NDM 1和OXA 48在CRE菌株中的表达。结果共分离203株CRE菌株,其中2016年全年CRE菌检出46株,检出率为0.59%(46/7849),2017年全年CRE菌检出84株,检出率为0.93%(84/9011),2018年1月至9月CRE菌检出73株,检出率为1.33%(73/5473);标本类型以痰液标本为主,占71.43%(145/203);临床科室分布以儿科为主,占30.05%(61/203);细菌种类以肺炎克雷伯菌为主,占57.14%(116/203)。药敏结果提示CRE对碳青霉烯类抗菌药物亚胺培南耐药率为100.0%,对厄他培南的耐药率为82.27%,对头孢唑林耐药率为95.07%,对喹诺酮类药物耐药率分别为左氧氟沙星44.33%,环丙沙星19.24%;对阿米卡星的敏感率最高,为77.34%。203株CRE菌株中NDM 1基因扩增阳性的菌株有78株,占38.42%,KPC基因阳性共有49株,占24.14%;其中NDM 1和HPC同时阳性者19例,占9.36%;IMP基因阳性共有56株,占27.59%;OXA 48基因阳性共有20株,占9.85%;未扩增出VIM耐药基因。结论CRE菌耐药严重,耐药基因以NDM 1为主,临床医生应加强耐药监测,合理选择抗菌药物。Objective To investigate the distribution,drug resistance and genotype of carbapenem resistant enterobacteriaceae(CRE)in hospitals,and to provide theoretical basis for clinical treatment of CRE infection.Methods CRE strains collected from January 2016 to September 2018 were identified by Vitek 2 Compact automatic microbiological analyzer.The expression of five re sistance genes KPC,IMP,VIM,NDM 1 and OXA 48 in CRE strain was detected by fluorescence quantitative PCR.Results A to tal of 203 strains of CRE were isolated.Among them,46 strains of CRE were detected in 2016,the detection rate was 0.59%(46/7849),84 strains were detected in 2017,the detection rate was 0.93%(84/9011),and 73 strains were detected from January to September 2018,and the detection rate was 1.33%(73/5473).The specimen type was mainly sputum specimens,accounting for 71.43%(145/203).The clinical department was mainly pediatric,accounting for 30.05%(61/203),the bacterial species were main ly Klebsiella pneumoniae,accounting for 57.14%(116/203).The drug sensitivity results suggested that the resistance rate of CRE to the antimicrobial drug imipenem was 100.0%,the resistance rate to ertapenem was 82.27%,and the resistance rate to cefazolin was 95.07%.The drug resistance rate to levofloxacin and ciprofloxacin was 44.33%and 19.24%respectively,for the highest of which was amikacin,77.34%.Among the 203 CRE strains,78 strains were positive for NDM 1 gene amplification,accounting for 38.42%.49 strains were positive for KPC gene amplification,accounting for 24.14%.Among them,19 cases were NDM 1 and HPC positive at the same time,accounting for 9.36%.56 strains were positive for IMP gene,accounting for 27.59%.20 strains were posi tive for OXA 48 genes,accounting for 9.85%.VIM resistance gene was not amplified.Conclusion The drug resistance of CRE bac teria is severe,and NDM 1 is the main drug resistance gene.Clinicians should strengthen drug resistance monitoring and select anti biotics reasonably.

关 键 词：肠杆菌科 基因 MDR Β内酰胺酶类 碳青霉烯酶 耐药基因 临床分布 

分 类 号：R446.5[医药卫生—诊断学]