碳青霉烯类耐药弗劳地枸橼酸杆菌耐药及毒力基因的分析  

Analysis of virulence and resistance genes of carbapenem resistant Citrobacter freundii

作　　者：杜娜 李焕芹 刘淑敏[2] 杜艳[2] 尧静 DU Na;LI Huan-qin;LIU Shu-min;DU Yan;YAO Jing(Department of Clinical Laboratory,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021,Yunnan Province,China;不详)

机构地区：[1]云南省中医医院检验科,云南昆明650021 [2]昆明医科大学第一附属医院检验科云南省实验诊断研究所云南省检验医学重点实验室,云南昆明650032

出　　处：《微生物学免疫学进展》2021年第1期17-22,共6页Progress In Microbiology and Immunology

基　　金：云南省基础研究计划中医联合青年项目(2019FF002(-081));云南中医药大学-云南中医药大学第一附属医院联合基金项目(XYLH2019011)。

摘　　要：目的对临床分离的碳青霉烯类耐药弗劳地枸橼酸杆菌(carbapenem resistant Citrobacter freundii,CRCF)进行耐药及毒力基因分析,为控制CRCF感染提供依据。方法收集昆明医科大学第一附属医院2016年1月至2017年12月22株CRCF,通过VITEK2 Compact系统对菌株进行细菌鉴定及药敏试验,用PCR检测菌株耐药及毒力基因的携带情况。结果药敏结果显示,菌株对青霉素类、头孢菌素类及碳青霉烯类抗生素的耐药率均为100%,对氨曲南、环丙沙星、左氧氟沙星、庆大霉素、四环素、复方新诺明及呋喃妥英等抗生素呈现出不同程度的耐药;22株菌株耐药基因检测结果显示,KPC-2、IMP、NDM-1、TEM、SHV和CTX等阳性率分别为27%、32%、82%、82%、23%和27%,携带2种或以上耐药基因的阳性率为91%;18株菌株毒力基因检测结果显示,ureA、wabG、ycf和uge等阳性率依次为41%、23%、14%和14%,未检测到IroN、allS、KfuB、iutA、ybtS、VatD及fimH等毒力基因。结论该院CRCF碳青霉烯类耐药性主要由NDM-1基因介导,而其毒力主要与脂多糖相关,多重耐药毒力强的CRCF应引起临床高度重视。Objective To analyze the virulence and resistance genes of carbapenem resistant Citrobacter freundii(CRCF)isolates,and to provide evidence for the control of CRCF infection.Methods 22 strains of CRCF were collected from January 2016 to December 2017 in The First Affiliated Hospital of Kunming Medical University.VITEK2 Compact system was used for bacterial identification and druy sensitivity test.Polymerase chain reaction(PCR)and sequencing were used to determine the resistance and virulence genes.Results The antibiotic susceptibility results showed that the strains exhibited complete resistance to penicillin,cephalosporin,enzyme inhibitors and carbapenem antibiotics,and different resistance levels to aztreonam,ciprofloxacin,levofloxacin,gentamicin,tetracycline,trimethoprim/sulfamethoxazole and nitrofurantoin.The positive rates of KPC-2,IMP,NDM-1,TEM,SHV and CTX were 27%,32%,82%,82%,23%and 27%,respectively.The positive rate of isolates which carried two or more resistant genes was 91%.The positive rates of virulence genes ureA,wabG,ycf and uge were 41%,23%,14%and 14%,respectively,and no virulence genes such as IroN,allS,KfuB,iutA,ybtS,VatD and fimH were detected.Conclusion The carbapenem resistance of Citrobacter freundii in the hospital was mainly mediated by the NDM-1 gene,and its virulence was mainly related to lipopolysaccharide.The co-existence of resistance and virulence genes should arouse great clinical attention.

关 键 词：碳青霉烯类耐药弗劳地枸橼酸杆菌 耐药基因 毒力基因 NDM-1酶 KPC-2酶 

分 类 号：R378.2[医药卫生—病原生物学]