呼吸道感染耐碳青霉烯类肠杆菌科细菌分子流行病学及临床特征  

Molecular epidemiology and clinical features of carbapenem-resistant Enterobacteria in respiratory tract

作　　者：王娟[1] 谢良伊[1] 蔡亮[2] 欧阳鹏文 姜斌 彭娜[1] 刘念[3] 李凤容[4] WANG Juan;XIE Liangyi;CAI Liang;OUYANG Pengwen;JIANG Bin;PENG Na;LIU Nian;LI Fengrong(Department of Clinical Laboratory,Hunan Provincial People′s Hospital/the First Affiliated Hospital of Hunan Normal University,Changsha,Hunan 410005,China;Microbiology Laboratory,Center for Disease Control and Prevention of Hunan Province,Changsha,Hunan 410005,China;Department of Respiration,Hunan Provincial People′s Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha,Hunan 410005,China;Department of Hospital Infection-Control,Hunan Provincial People′s Hospital/the First Affiliated Hospital of Hunan Normal University,Changsha,Hunan 410005,China)

机构地区：[1]湖南省人民医院/湖南师范大学附属第一医院检验科,湖南长沙410005 [2]湖南省疾病预防控制中心微生物检验科,湖南长沙410005 [3]湖南省人民医院/湖南师范大学附属第一医院呼吸内科,湖南长沙410005 [4]湖南省人民医院/湖南师范大学附属第一医院院感科,湖南长沙410005

出　　处：《国际检验医学杂志》2020年第22期2752-2755,2760,共5页International Journal of Laboratory Medicine

基　　金：湖南省自然科学基金项目(2017JJ3173)。

摘　　要：目的分析呼吸道感染耐碳青霉烯类肠杆菌科细菌(CRE)主要耐药机制、分子流行病学特征及其临床特征。方法收集2018年湖南省人民医院/湖南师范大学附属第一医院非重复呼吸道感染CRE 114株,所有菌株均用VITEK2 Compact全自动微生物分析系统进行鉴定及体外药敏试验;改良碳青霉烯灭活试验进行表型试验;PCR检测碳青霉烯酶基因并进行多位点序列分型,并用χ^2检验和Logistic回归对临床数据进行统计学分析。结果114株非重复呼吸道感染CRE中肺炎克雷伯菌108株,大肠埃希菌2株,阴沟肠杆菌4株。114株CRE中85株检出产碳青霉烯酶,占74.56%;其中肺炎克雷伯菌以KPC-2型为主(73.15%);大肠埃希菌未检测出酶基因,1株阴沟肠杆菌检出NDM-1;肺炎克雷伯菌共分出6种ST型,以ST11为主要表型,其次为ST17;大肠埃希菌分出1种ST型,为ST167;4株阴沟肠杆菌为ST592。114株CRE分为产酶株与非产酶株,运用χ^2检验和Logistic回归分析显示,早期的碳青霉烯类抗菌药物使用者所占比例在产酶株与非产酶株中差异有统计学意义(P<0.05),且其是产酶株的危险因素(OR:3.722,95%CI:1.529~9.057)。结论产碳青霉烯酶为CRE耐药的主要原因,ST11为肺炎克雷伯菌的主要流行基因型,早期的碳青霉烯类抗菌药物暴露是产酶株的危险因素。Objective To explore the main drug resistance mechanism,molecular epidemiology of carbapenem-resistant Enterobacteriaceae(CRE)in the respiratory tract and clinical characteristics.Methods A total of non-repetitive respiratory CRE were collected in 2018.All strains were identified and tested in vitro by VITEK2 Compact.Phenotypic experiment was done by mCIM test.The carbapenemase gene was detected and sequenced by PCR.The clinical data were statistically analyzed throughχ^2 test and Logistic regression analysis.Results Among 114 non-repetitive respiratory CRE,there were 108 strains of Klebsiellapneumoniae,2 strains of Escherichia coli,and 4 strain of Enterobacter cloacae.A total of 85 carbapenemase genes were detected in 114 strains of CRE,accounting for 74.56%.K.pneumoniae was mainly KPC-2(73.15%).E.coli wasn′t detected the enzyme gene,1 strain Enterobacter cloacae was detected NDM-1.Klebsiellapneumoniae was isolated six kinds of ST type,with ST11 as the main phenotype,followed by ST17,E.coli was ST167,4 strains Enterobacter cloacae was ST592.A total of 114 strains of CRE were divided into enzyme-producing strains and non-producing enzyme strains.χ^2 test and Logistic regression analysis showed that there was a statistically significant difference on the cases used carbapenem antibiotics early between the enzyme strain and the non-produced strain(P<0.05),and early exposure to carbapenem antibiotics was a risk factor for producing the enzyme strain(OR was 3.722,95%CI was 1.529-9.057).Conclusion Carbapenemase is the main resistance mechanism of CRE.ST11 is the main epidemic clone of Klebsiellapneumoniae,and early exposure to carbapenem antibiotics is risk factor of CRE.

关 键 词：肠杆菌科细菌 碳青霉烯酶 临床特征 

分 类 号：R446.5[医药卫生—诊断学]