某三甲医院耐碳青霉烯类肠杆菌科细菌耐药性和耐消毒剂基因分析  

Drug resistance and disinfectant-resistant genes in carbapenem-resistant Enterobacteriaceae in a three-A hospital

作　　者：张甜甜 刘志武[2] 徐腾飞[2] 武涛 陈琳[3] ZHANG Tian-tian;LIU Zhi-wu;XU Teng-fei;WU Tao;CHEN Lin(The First Clinical Medical College of Lanzhou University,Lanzhou,Gansu 730000,China;不详)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院检验科,甘肃兰州730000 [3]兰州大学第一医院传染科,甘肃兰州730000

出　　处：《中华医院感染学杂志》2023年第3期325-329,共5页Chinese Journal of Nosocomiology

基　　金：甘肃省自然科学基金资助项目(21JR1RA082);兰州大学第一医院院内基金资助项目(ldyyyn2017-31)。

摘　　要：目的了解耐碳青霉烯类肠杆菌科细菌(CRE)临床分离菌株的耐药特征,检测分析耐消毒剂基因携带情况。方法收集兰州大学第一医院2021年1-12月临床送检的住院患者包括痰、血及胸腹水等各类标本,共获得不重复菌株210株,进行菌株鉴定及药敏试验;聚合酶链反应(PCR)方法检测耐消毒剂基因携带情况。结果210株CRE菌株主要为肺炎克雷伯菌和阴沟肠杆菌,分别占64.29%(135/210)和22.86%(48/210);科室分布主要为重症监护病房46.67%(98/210);标本来源主要为痰49.52%(104/210)、血液12.86%(27/210)、分泌物9.52%(20/210);210株CRE菌株耐药率最低的抗菌药物是阿米卡星(49.52%);对庆大霉素、四环素、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、氨曲南和厄他培南的耐药率分别为67.62%、72.38%、83.33%、75.71%、84.76%和98.10%,对其余抗菌药物的耐药率均高达100.00%。210株临床分离的CRE均未检出qacA、qacC、qacJ基因,检出qacB、qacG、qacH、qacE、qacE△1和qacE△1-SUL1基因阳性率分别为1.43%(3/210)、0.95%(2/210)、1.90%(4/210)、66.67%(140/210)、80.95%(170/210)和91.43%(192/210)。结论CRE菌株对常用抗菌药物普遍耐药,应加强对CRE菌株的耐药性监测,根据药敏结果合理选择抗菌药物,减少耐药株的产生;临床分离的CRE耐消毒剂基因携带率较高,且以qacE、qacE△1和qacE△1-SUL1为主,应进一步加强消毒剂耐药菌株的监控,根据消毒剂耐药情况合理调整消毒剂的使用,预防医院感染发生。OBJECTIVE To understand the drug resistance characteristics of clinical isolates of carbapenem-resistant Enterobacteriaceae(CRE),and to detect and analyze the carriage of disinfectant-resistant genes.METHODS A total of 210 non-repeating strains were obtained from various specimens including sputum,blood,pleural and ascites fluid from inpatients send to the First Hospital of Lanzhou University from Jan.to Dec.2021.Strain identification and drug sensitivity test were carried out.Polymerase chain reaction(PCR)method was used to detect the carrying of disinfectant-resistant genes.RESULTS The 210 CRE strains were mainly Klebsiella pneumoniae and Enterobacter cloacae,accounting for 64.29%(135/210)and 22.86%(48/210),respectively.The distribution of units was mainly in intensive care unit,accounting for 46.67%(98/210).The sources of specimens were mainly sputum of 49.52%(104/210),blood of 12.86%(27/210),and secretions of 9.52%(20/210)respectively.Among the 210 CRE strains,the antimicrobial drug with the lowest resistance rate was amikacin(49.52%).The resistance rates to gentamicin,tetracycline,levofloxacin,compound sulfamethoxazole,aztreonam and ertapenern were 67.62%,72.38%,83.33%,75.71%,84.76%and 98.10%,respectively,and the resistance rates to the rest of antibiotics were as high as 100.00%.The qacA,qacC and qacJ genes were not detected in the 210 CRE isolates.The positive rates of qacB,qacG,qacH,qacE,qacE△1 and qacE△1-SUL1 genes were 1.43%(3/210),0.95%(2/210),1.90%(4/210),66.67%(140/210),80.95%(170/210)and 91.43%(192/210),respectively.CONCLUSION The CRE strains were generally resistant to commonly used antibiotics,therefore,the monitoring of resistance of CRE strains should be strengthened,and antibiotics should be rationally selected according to the results of drug sensitivity to reduce the generation of resistant strains.The carriage rate of disinfectant-resistance genes in clinical isolates of CRE was high and dominated by qac E,qacE△1and qac.E△1-SUL1 The surveillance of disinfectant-resistant strains shou

关 键 词：耐碳青霉烯类肠杆菌科细菌 耐药性 耐消毒剂基因 携带率 

分 类 号：R378[医药卫生—病原生物学]