GeneXpert检测系统分析儿童耐碳青霉烯类肠杆菌科细菌耐药基因  

Analysis of resistance genes of carbapenem resistant Enterobacteriaceae in children by GeneXpert detection system

作　　者：王维[1] 王林[2] WANG Wei;WANG Lin(Department of Clinical Laboratory,Xi′an Children Hospital,Xi′an,Shaanxi 710003,China;Department of Clinical Laboratory,Xi′an NO.1 Hospital,Xi′an,Shaanxi 710002,China)

机构地区：[1]陕西省西安市儿童医院检验科,陕西西安710003 [2]陕西省西安市第一医院检验科,陕西西安710002

出　　处：《检验医学与临床》2021年第10期1369-1372,共4页Laboratory Medicine and Clinic

基　　金：陕西省重点研发计划(2017SF-119)。

摘　　要：目的研究西安市儿童医院2017年10月至2019年10月临床分离耐碳青霉烯类肠杆菌科细菌(CRE)的耐药情况,借助GeneXpert检测系统分析碳青霉烯酶基因携带特点,了解其分子流行病学分布,为各科室CRE的预防、控制及治疗提供依据。方法采用Whonet 5.6软件筛选西安市儿童医院2017年10月至2019年10月CRE菌株,采用基质辅助激光解吸/电离飞行时间质谱仪鉴定细菌,以Vitek 2-Compact全自动微生物鉴定及药敏分析系统联合纸片扩散法(K-B法)进行药敏试验,采用GeneXpert检测系统检测碳青霉烯酶基因KPC、NDM、VIM、IMP-1、OXA-48。结果西安市儿童医院2017年10月至2019年10月共检出CRE菌株109株,排名前3位的是肺炎克雷伯菌57株(52.29%)、大肠埃希菌20株(18.35%)、产酸克雷伯菌8株(7.34%)。标本来源主要为尿液(35.78%)、下呼吸道标本(29.36%)、脓液(16.51%)。临床科室分布主要集中在新生儿重症医学科、康复科及血液科。药敏试验结果显示,CRE对β-内酰胺类药物耐药率在80.00%以上,对氨基糖苷类和喹诺酮类抗菌药物耐药率均小于40.00%。GeneXpert检测系统检测结果显示,携带碳青霉烯酶菌株共90株,耐药基因检出率分别为KPC(52.29%)、NDM(47.70%)、IMP-1(7.30%),未发现VIM和OXA-48耐药基因。患儿预后与细菌耐药基因检出数量种类差异无统计学意义(P>0.05)。结论儿童CRE以肺炎克雷伯菌为主,大部分来源于重症医学科的下呼吸道标本,对抗菌药物高度耐药,检出耐药基因以KPC和NDM为主。耐碳青霉烯类肠杆菌科细菌耐药形势严峻,临床应根据药敏试验结果合理选用抗菌药物,及时针对性地采取措施,以预防院内传播流行。Objective To investigate the drug resistance of carbapenem-resistant enterobacteriaceae(CRE)clinically isolated from Xi′an children′s Hospital from October 2017 to October 2019.With the help of GeneXpert detection system,the carrying characteristics of carbapenemase gene were analyzed to understand its molecular epidemiological distribution,so as to provide the basis for the prevention,control and treatment of CRE in various departments.Methods The CRE strains from Xi′an children′s Hospital from October 2017 to October 2019 were analysed by Whonet 5.6 software,and identified by MALDI-TOF-MS.The Vitek 2-Compact automatic microbiological identification and drug sensitivity analysis system combined with disk diffusion method(K-B method)was used for the drug sensitivity test,and GeneXpert detection system was used to detected carbapenemase genes,including KPC,NDM,VIM,IMP-1,OXA-48.Results A total of 109 CRE strains were detected in the hospital from October 2017 to October 2019.The top three strains were Klebsiella pneumoniae(57 strains,52.29%),Escherichia coli(20 strains,18.35%)and Klebsiella acidophilus(8 strains,7.34%).The main CRE strains of specimens were urine(35.78%),respiratory tract(29.36%),and pus(16.51%).The clinical departments that isolated CRE strains were concentrated in neonatal intensive care unit,department of rehabilitation and department of hematology.The drug sensitivity results showed that the resistance rate of CRE strain toβ-lactam was more than 80.00%,and that to aminoglycoside and quinolones was less than 40.00%.GeneXpert test showed that there were 90 strains carrying carbapenase,and the detection rates of drug-resistant genes of KPC,NDM,IMP-1 were 52.29%,47.70%and 7.30%respectively.VIM and OXA-48 drug-resistant genes were not found.There was no statistical difference between the prognosis of children and the number or types of bacterial drug-resistant genes detected(P>0.05).Conclusion The CRE strains in children are mainly Klebsiella pneumoniae,most of which are isolated from the l

关 键 词：耐碳青霉烯类肠杆菌 儿童 GeneXpert检测系统 耐药性 

分 类 号：R446.5[医药卫生—诊断学]