2015—2020年某院CRE分布、耐药性及碳青霉烯酶基因检测结果分析  

Analysis of CRE distribution,drug resistance and carbapenemase gene detection results in a hospital from 2015 to 2020*

作　　者：黄加铭 王启[2] 徐玉金 孙细欢 黄东红[1] HUANG Jiaming;WANG Qi;XU Yujin;SUN Xihuan;HUANG Donghong(Microbiology Laboratory,the Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362300,China;Department of Clinical Laboratory,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]福建医科大学附属第二医院微生物实验室,福建泉州362300 [2]北京大学人民医院检验科,北京100044

出　　处：《检验医学与临床》2023年第4期490-494,共5页Laboratory Medicine and Clinic

基　　金：福建省卫生计生科研人才培养项目(2018-2-22);福建省自然科学基金项目(2020J01212);福建省泉州市科技计划项目(2018N026S)。

摘　　要：目的了解碳青霉烯耐药肠杆菌(CRE)的临床分布、耐药性及碳青霉烯酶基因型,为CRE感染的治疗及医院感染防控提供依据。方法收集2015年1月1日至2020年12月31日福建医科大学附属第二医院临床分离的CRE菌株,采用microflex LRF MALDI-TOF型质谱微生物鉴定仪进行菌种鉴定;采用微量肉汤稀释法或琼脂稀释法检测多黏菌素B、替加环素、头孢他啶/阿维巴坦和磷霉素等16种抗菌药物的最低抑菌浓度(MIC)。采用聚合酶链反应检测常见碳青霉烯酶基因(blaKPC、blaNDM、blaIMP、blaVIM、blaOXA-48)及黏菌素耐药基因mcr-1并测序确认;采用多位点序列分型(MLST)法确定肺炎克雷伯菌的序列分型(ST)。结果38株CRE中,肺炎克雷伯菌15株,大肠埃希菌13株,其他肠杆菌目细菌10株;主要分离自痰液、血液及尿液标本;来自普内科的分离率占比最高(23.69%);38株CRE对替加环素、多黏菌素B呈现较低耐药率(5.26%、13.16%),对阿米卡星、磷霉素、米诺环素和氨曲南的耐药率均<53%,对其他药物的耐药率均>71%。最常见的碳青霉烯酶基因型是blaNDM(65.71%),其次是blaKPC(22.86%)和blaIMP(8.57%),在15株肺炎克雷伯菌中鉴定出9种不同的ST,其中ST11型7株(46.67%)。结论该院CRE仅对替加环素、多黏菌素B等少数抗菌药物呈现较好敏感性,产blaNDM型碳青霉烯酶是肠杆菌目细菌对碳青霉烯类抗菌药物耐药的主要原因;ST11型肺炎克雷伯菌是碳青霉烯耐药肺炎克雷伯菌的主要流行克隆菌株,未发现该地区的克隆菌株暴发流行。Objective To investigate the clinical distribution,drug susceptibility and carbapenemase genotypes of carbapenem-resistant Enterobacterales(CRE),to provide the evidence for CRE therapy and nosocomial infection control.Methods CRE strains were collected from the Second Affiliated Hospital of Fujian Medical University from January 1,2015 to December 31,2020,the isolates were re-identified by microflex LRF MALDI-TOF type mass spectrometry microbiological identification instrument.The minimum inhibitory concentrations(MIC)of tigecycline,colistin,fosfomycin and other antibacterial drugs were determined using microdilution or agar dilution method.Polymerase chain reaction was used to detect the presence of carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM,blaOXA-48)and colistin resistance gene(mcr-1),multilocus sequence typing(MLST)was used to analyze sequence typing(ST)of Klebsiella pneumoniae strains.Results Among the 38 strains of CRE,15 strains were Klebsiella pneumoniae,13 strains were Escherichia coli,10 strains were other Enterobacterales.The 38 CRE strains were mainly isolated from sputum,blood and urine samples.The distribution rate of Department of General Intemal Medicine was the highest(23.69%).The 38 CRE strains showed low resistance rates to tigecycline(5.26%)and colistin(13.16%).The resistance rates to amikacin,fosfomycin,minocycline and aztreonam were<53%,and the resistance rates to other drugs were>71%,most common detected carbapenemase gene was blaNDM(65.71%),followed by blaKPC(22.86%)and blaIMP(8.57%).Nine distinct ST were identified among 15 Klebsiella pneumoniae,there was 7 tranis were ST11 tye among them.Conclusion The CRE strains were only susceptible to a few antibacterial drugs,such as tigecycline and colistin.The production of blaNDM carbapenemase was the main reason for the resistance of Enterobacterales to carbapenems.ST11 type Klebsiella pneumoniae was the main epidemic clone of carbapenem-resistant Klebsiella pneumoniae.No outbreaks of clonal strains in this region.

关 键 词：肠杆菌目细菌 碳青霉烯酶 耐药性 

分 类 号：R446.5[医药卫生—诊断学]