东莞地区肠杆菌科细菌碳青霉烯酶的表型与基因型分析  

Phenotype and genotype analysis of Carbapenase of enterobacteriaceae bacteria in Dongguan

作　　者：黄亚 谢树金 林偲思[1] 朱艳 王套瑞 吕飞 程理维 方颖 黄晓君 谢佩 陈青诗 郭主声[1] HUANG Ya;XIE Shu-jin;LIN Si-si;ZHU Yan;WANG Tao-rui;LV Fei;CHENG Li-wei;FANG Ying;HUANG Xiao-jun;XIE Pei;CHEN Qing-shi;GUO Zhu-sheng(Department of Laboratory Medicine,Dongguan Donghua Hospital Affiliated to Sun Yat-sen University,Dongguan 523110,Guangdong,CHINA;Department of Parasites,College of Basic Medicine,Guangdong Medical University,Zhanjiang 524000,Guangdong,CHINA;Department of Microbiology and Immunology,College of Basic Medicine,Guangdong Medical University,Zhanjiang 524000,Guangdong,CHINA)

机构地区：[1]中山大学附属东莞东华医院检验科,广东东莞523110 [2]广东医科大学基础医学院寄生虫教研室,广东湛江524000 [3]广东医科大学基础医学院微生物与免疫教研室,广东湛江524000

出　　处：《海南医学》2022年第10期1270-1274,共5页Hainan Medical Journal

基　　金：2019年广东省东莞市社会科技发展(重点)项目(编号:201950715046197)。

摘　　要：目的了解东莞地区耐碳青霉烯类肠杆菌科细菌(CRE)临床感染分布、耐药情况以及产碳青霉烯酶的表型与基因型,完善东莞地区耐药监测信息,为临床控制和治疗CRE的感染提供可靠依据。方法使用VITEK 2 Compact全自动细菌鉴定药敏系统分析仪系统对东莞耐药监测网2020年收集的40株CRE菌株进行菌种鉴定与药敏试验,采用纸片扩散法(K-B法)和E-test法测定药敏。采用碳青霉烯酶抑制剂增强试验检测碳青霉烯酶表型,采用GeneXpert Carba-R检测和鉴定碳青霉烯酶的基因型。使用WHONET 5.6软件和SPSS23.0软件进行统计分析。结果40株CRE菌株中检出最高的是肺炎克雷伯菌27株(占67.5%),其次是大肠埃希菌10株(占25%);标本中检出率最高的是呼吸道标本(16株,占40%),其次是尿液标本(7株,占17.5%);40株CRE药敏结果显示,亚胺培南的耐药率为92.5%,美罗培南的耐药率为97.5%,替加环素的耐药率较低为40%;碳青霉烯酶型检测结果显示有37株(占92.5%)产生碳青霉烯酶,其中产A类丝氨酸碳青霉烯酶阳性24株(占60.0%),产B类金属β内酰胺酶阳性13株(占32.5%),未检出碳青霉烯酶菌株3株(占7.5%);GeneXpert Carba-R测定法检测出碳青霉烯酶基因共37株(占92.5%),检出13株blaNDM(占32.5%),24株blaKPC(占60%);携带blaKPC的CRE菌株对阿米卡星、替加环素和氨曲南的耐药率比携带blaNDM的CRE菌株的高,差异有统计学意义(P<0.05)。结论东莞地区分离的CRE菌株以产A类丝氨酸碳青霉烯酶和产B类金属β-内酰胺酶的菌株为主。检出的碳青霉烯酶基因型主要为blaNDM和blaKPC,其中携带blaNDM的CRE菌株对阿米卡星、替加环素和氨曲南的耐药率较低。GeneXpert Carba-R可以快速检测并鉴定碳青霉烯酶基因型。建议实验室同时进行表型和基因型的检测,指导临床合理使用抗生素。Objective To understand the distribution of clinical infection,drug resistance,and the phenotype and genotype of carbapenem-resistant Enterobacteriaceae(CRE)bacteria in Dongguan,improve the monitoring information of drug resistance in Dongguan,and provide reliable basis for clinical control and treatment of CRE infection.Methods A total of 40 CRE strains collected by Dongguan Drug Resistance Monitoring Network in 2020 were identified and tested by VITEK 2 Compact automatic bacterial identification and drug sensitivity system analyzer.Antimicrobial susceptibility testing was determined by disk diffusion method(K-B method)and E-test method.The phenotype of carbapenem was detected by carbapenem inhibitor enhancement test,and the genotype of carbapenem was detected and identified by GeneXpert Carba-R.The WHONET 5.6 software and SPSS23.0 software were used for statistical analysis.Results Among the 40 CRE strains,Klebsiella pneumoniae(27 strains,accounting for 67.5%)were the mostly detected,followed by Escherichia coli(10 strains,accounting for 25%).Among the specimens,the highest detection rate was in respiratory specimens(16 strains,accounting for 40%),followed by urine specimens(7 strains,accounting for 17.5%).The drug sensitivity results of 40 CRE strains showed that the antibiotic resistance rate of imipenem,meropenem,and tigecycline were 92.5%,97.5%,40%,respectively.Results showed that 37 strains(accounting for 92.5%)produced carbapenemase,of which 24 strains(accounting for 60%)produced class A serine carbapenemase,and 13 strains(accounting for 32.5%)were positive for class B metallo-β-lactamasee,and 3 strains(accounting for 7.5%)were not detected with carbapenemases.A total of 37 carbapenemase genes(accounting for 92.5%)were detected by the GeneXpert Carba-R assay,including blaNDM(13 strains,accounting for 32.5%)and blaKPC(24 strains,accounting for 60%).CRE strains carrying blaKPC showed higher resistance to amikacin,tigecycline and aztreonam than CRE strains carrying blaNDM,and the difference was statisticall

关 键 词：耐碳青霉烯类肠杆菌科细菌 碳青霉烯酶抑制剂增强试验 肺炎克雷伯氏菌碳青霉烯酶 新德里金属-β-内酰胺酶 

分 类 号：R378.2[医药卫生—病原生物学]