GeneXpert技术对耐碳青霉烯类肠杆菌科细菌耐药基因分析  

Genotypic Analysis of Carbapenem-resistance Enterobacteriaceaeby GeneXpert Technology

作　　者：王维[1] 王林[2] 樊清清 赵亚 WANG Wei;WANG Lin;FAN Qingqing;ZHAO Ya(Clinical Laboratory,Xi’an Children’s Hospital,Xi’an710003,China;Clinical Laboratory,Xi’an NO.1 Hospital,Xi’an710002,China;Department of Pharmacy,Xi’an NO.1 Hospital,Xi’an710002,China)

机构地区：[1]西安市儿童医院检验科,西安710003 [2]西安市第一医院检验科,西安710002 [3]西安市第一医院药剂科,西安710002

出　　处：《宁夏医科大学学报》2020年第12期1254-1257,共4页Journal of Ningxia Medical University

基　　金：陕西省重点研发计划(2017SF-119)。

摘　　要：目的分析西安市第一医院耐碳青霉烯类肠杆菌科细菌(CRE)的药物敏感性及碳青霉烯酶基因携带情况,了解其分子流行病学特征,为CRE的防控提供依据。方法采用WHONET 5.6软件对本院2017年3月至2019年3月培养的CRE菌株进行初筛,采用基质辅助激光解吸/电离飞行时间质谱仪进行细菌鉴定,Vitek 2-Compact全自动微生物鉴定及药敏分析系统进行药物敏感性实验,GeneXpert检测碳青霉烯酶基因KPC、NDM、IMP-1、VIM、OXA-48。结果70株CRE以肺炎克雷伯菌为主(37.14%),其次为大肠埃希菌(21.43%)和弗氏枸橼酸杆菌(10.00%)。标本来源以痰液为主(58.57%),其次为血液(18.57%)和尿液(18.57%)。临床科室分布以康复重症医学科为主(28.57%),其次为神经外科和呼吸内科(均各占18.57%)。药敏结果提示CRE对大部分β-内酰胺类药物呈现高度耐药,耐药率>80%,对阿米卡星有较好的敏感性,敏感率为56.0%。GeneXpert结果显示57株菌携带碳青霉烯酶,其中KPC和NDM检出率较高,分别为51.43%和47.14%;IMP-1检出率较低,为5.71%;未检测出VIM和OXA-48耐药基因。患者不同预后情况中,CRE菌株耐药基因检出情况差异无统计学意义(χ2=1.57,P=0.456)。结论本院分离的CRE对多种抗菌药物高度耐药,耐药基因以KPC为主,其次为NDM,临床应加强对CRE的监控,根据药物敏感性结果合理选用抗菌药物,预防CRE菌株院内传播流行。Objective To investigate the characteristics and drug sensitivity of carbapenem-resistance Enterobacteriaceae(CRE)infection in Xi’an NO.1 Hospital,and study the genotypic analysis of carbapenemase genes so as to provide guidance for CRE infection.Methods ALL of the CRE strains that were isolated from Mar 2017 to Mar 2019 were taken for statistics by using WHONET 5.6 software,the strains were identified by using MALDI-TOF-MS,the antibiotics-sensitivity were tested by VITEK2-Compact automatic microbiological identification and drug sensitivity analysis system,and the carbapenemase genes(KPC,NDM,IMP-1,VIM,OXA-48)were detected by GeneXpert technology.Results Klebsiella pneumoniae was dominated in all CRE strains,accounting for 37.14%,followed by Escherichia coli(21.43%)and Citrobacter freundii(10.00%).CRE strains samples were mainly isolated from sputum,accounting for 58.57%,followed by blood(18.57%)and urine(18.57%).Most of the patients were from rehabilitation section accounting for 28.57%,followed by neurosurgery(18.57%)and respiratory medicine(18.57%).The drug sensitivity test showed CRE strains were high resistant to most ofβ-lactam antibiotics,the resistantce rate was higher than 80%,the resistant rate to amikacin were 44%which had better sensitivity.The results of GeneXpert showed 57 strains carrying carbapenemase.The positive rates of the drug resistance genes KPC(51.43%)and NDM(47.14%)were the highest,the positive rates of the drug resistance gene IMP-1 was 5.71%,the positive rates of the drug resistance gene VIM and OXA-48 were not detected.There was no significant difference between the number of resistant genes and the prognosis of patients(χ2=1.57,P=0.456).Conclusion CRE strains is highly resistant to most antibiotics in our hospital,and the main resistant gene is KPC,followed by NDM.The surveillance of carbapenem-resistant Enterobacterium should be strengthened in clinic and antimicrobial agents should be rationally selected based on drug sensitivity results so as to prevent the outbreak of infectio

关 键 词：肠杆菌科细菌 碳青霉烯酶 耐药性 基因检测平台 

分 类 号：R446.5[医药卫生—诊断学]