耐碳青霉烯肠杆菌科细菌的耐药性和分子特征  

Molecular characteristics of carbapenem resistant Enterobacteriaceae

作　　者：崔超琼 周义正[1] 李承彬[1] CUI Chaoqiong;ZHOU Yizheng;LI Chengbin(Department of Laboratory Medical,Jingzhou Central Hospital,Jingzhou,Hubei 434020,China)

机构地区：[1]湖北省荆州市中心医院医学检验部,湖北荆州434020

出　　处：《检验医学与临床》2020年第17期2455-2459,2463,共6页Laboratory Medicine and Clinic

基　　金：湖北省卫生和计划生育委员会联合基金项目(WJ2018H186)。

摘　　要：目的了解该院耐碳青霉烯肠杆菌科细菌(CRE)的流行特点、耐药现状及分子型别,为控制CRE的传播及临床治疗提供科学依据。方法收集该院微生物室2017年1月至2019年5月临床标本中分离的91株CRE,使用Vitek 2 Compact全自动细菌鉴定系统进行细菌鉴定和药敏试验,改良碳青霉烯灭活试验(mCIM)和乙二胺四乙酸改良碳青霉烯灭活试验(eCIM)联合检测碳青霉烯酶表型,采用PCR扩增耐药基因,多位点序列分型(MLST)分析菌株间同源性,采用WHONET5.6和SPSS23.0进行统计分析。结果91株CRE菌株中,肺炎克雷伯菌42株,大肠埃希菌23株,阴沟肠杆菌15株,其他CRE 11株。CRE菌株对替加环素和阿米卡星敏感性较高,但对其他大部分抗菌药物耐药性较高。mCIM筛选碳青霉烯酶的灵敏度为97.1%,特异度为100.0%。60株CRE携带1种碳青霉烯酶基因,8株CRE菌株合并2种碳青霉烯酶基因,毒力基因wcaG检出率为2.4%。耐碳青霉烯类药物肺炎克雷伯菌的MLST结果是ST11型12株,ST37型8株,ST17型8株,ST147型2株,ST48型1株;耐碳青霉烯类药物大肠埃希菌的MLST结果是ST167型17株;耐青霉烯类药物阴沟肠杆菌的MLST结果是ST418型6株,ST93型4株,ST74型2株,ST175型1株。结论该院CRE菌株对碳青霉烯类抗菌药物的耐药机制复杂。分子型别较多,各菌种呈现不同特点。Objective To understand the epidemic characteristics,resistance phenotypes and homology of carbapenem resistant Enterobacteriaceae(CRE)and to provide experimental basis for the control of CRE transmission and treatment.Methods A total of 91 strains of CRE were collected from the clinical samples of Jingzhou Central Hospital from January 2017 to May 2019.VITEK 2 Compact automatic bacterial identification system was used for bacterial identification and drug sensitivity test,modified carbapenemase inactivation test(mCIM)and ethylenediamine tetraacetic acid modified carbapenemase inactivation test(eCIM)were used to detect the phenotype of carbapenemase,PCR was used to amplify the drug-resistant gene,multi locus sequence typing(MLST)was used to analyze the homology among strains,WHONET5.6 and SPSS23.0 were used for statistical analysis.Results Among the 91 CRE strains,there were 42 strains of Klebsiella pneumoniae,23 strains of Escherichia coli and 15 strains of Enterobacter cloacae,and 11 strains of others.CRE strains were highly sensitive to tigecycline and amikacin,but resistant to most other antibiotics.The sensitivity and the specificity of mCIM were 97.1%and 100.0%.60 strains of CRE strains had one kind of carbapenemase gene,and 8 strains of CRE had two kinds of carbapenemase genes.The detection rate of virulence gene wcaG was 2.4%.The MLST of carbapenem resistant Klebsiella pneumoniae was 12 strains of ST11,8 strains of ST37,8 strains of ST17,2 strains of ST147 and 1 strain of ST48.The MLST of carbapenem resistant Escherichia coli was 17 strains of ST167.The MLST of carbapenem resistant Enterobacter cloacae was 6 strains of ST418,4 strains of ST93,2 strains of ST74 and 1 strain of ST175.Conclusion The resistance mechanism of CRE strains to carbapenems is complex.There are many molecular types,and each strain has different characteristics.

关 键 词：耐碳青霉烯肠杆菌科细菌 耐药机制 碳青霉烯酶 膜孔蛋白 MLST 

分 类 号：R446.5[医药卫生—诊断学]