耐碳青霉烯类肠杆菌目细菌耐消毒剂基因及四种消毒剂最低抑菌浓度检测  

Detection of disinfectant-resistant genes and minimum inhibitory concentrations of four disinfectants in carbapenem-resistant Enterobacterales

作　　者：刘志武[1] 张甜甜 黄喜凤 徐腾飞[1] 陈琳[4] LIU Zhi-wu;ZHANG Tian-tian;HUANG Xi-feng;XU Teng-fei;CHEN Lin(Department of Laboratory Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,China;The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;The Second Ward of Lanzhou Pulmonary Hospital,Lanzhou 730000,China;Department of Infectious Diseases,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院检验科,甘肃兰州730000 [2]兰州大学第一临床医学院,甘肃兰州730000 [3]兰州市肺科医院二病区,甘肃兰州730000 [4]兰州大学第一医院传染科,甘肃兰州730000

出　　处：《中国感染控制杂志》2023年第5期497-503,共7页Chinese Journal of Infection Control

基　　金：甘肃省自然科学基金(21JR1RA082)。

摘　　要：目的 了解临床分离耐碳青霉烯类肠杆菌目细菌(CRE)耐消毒剂基因qacE、qacE△1、qacE△1-SUL1携带情况,以及四种常用消毒剂最低抑菌浓度(MIC),为医院做好科学消毒提供参考依据。方法 收集某院2021年10月—2022年3月所有临床送检标本分离的CRE非重复菌93株,对菌株进行鉴定和药敏试验,采用聚合酶链反应(PCR)方法检测菌株耐消毒剂基因qacE、qacE△1和qacE△1-SUL1携带情况,采用琼脂稀释法检测戊二醛、碘伏、84消毒剂(含氯消毒剂)和乙醇对CRE的MIC值。结果 93株CRE以肺炎克雷伯菌(52株)和阴沟肠杆菌(25株)为主;CRE菌株耐药率较高,对大部分抗菌药物耐药率达100%;耐消毒剂基因qacE、qacE△1和qacE△1-SUL1携带率分别为72.0%(67株)、81.7%(76株)、89.2%(83株)。四种消毒剂对CRE的MIC值,戊二醛为500 mg/L,碘伏为625~2 500 mg/L,84消毒剂(有效氯浓度)为250~500 mg/L,乙醇为75%;碘伏中有4株CRE MIC值(2 500 mg/L)高于标准菌株,84消毒剂中有24株CRE MIC值(有效氯500 mg/L)高于标准菌株。结论 该院临床分离的CRE耐消毒剂基因携带率较高,部分CRE菌株对碘伏和84消毒剂有抗性,临床工作中需科学、规范地使用消毒剂,防止耐药菌医院内传播。Objective To investigate the prevalence of qac E,qac E△1,and qac E△1-SUL1 disinfectant-resistant genes and the minimum inhibitory concentrations(MICs)of four commonly used disinfectants for carbapenem-resistant Enterobacterales(CRE),providing reference for the scientific disinfection in hospitals.Methods 93 non-duplicate CRE strains isolated from all clinical specimens in a hospital from October 2021 to March 2022 were collected.The strains were identified and tested for antimicrobial susceptibility.Polymerase chain reaction(PCR)was used to detect the presence of disinfectant-resistant genes qac E,qac E△1,and ac E△1-SUL1,and the MICs of glu-taraldehyde,iodophor,“84”disinfectant(chlorine-containing disinfectant)and ethanol to CRE were determined using agar dilution method.Results 93 CRE strains were mainly Klebsiella pneumoniae(52 strains)and Ente-robacter cloacae(25 strains).The resistance rates of CRE strains to most antimicrobial drugs were up to 100%.The prevalence rates of disinfectant-resistant genes qac E,qac E△1,and ac E△1-SUL1 were 72.0%(67 strains),81.7%(76 strains)and 89.2%(83 strains),respectively.The MICs of glutaraldehyde,iodophor,“84”disinfec-tant(effective chlorine concentration)and ethanol to CRE were 500 mg/L,625-2500 mg/L,250-500 mg/L and 75%,respectively.The MICs of iodophor(2500 mg/L)to 4 CRE strains and“84”disinfectant(effective chlorine concentration 500 mg/L)to 24 CRE strains were higher than the standard strains.Conclusion The prevalence of disinfectant-resistant genes among the CRE strains isolated from this hospital is high.CRE strains are partially resistant to iodophor and“84”disinfectant.Disinfectants should be used scientifically and properly in clinical practice,so as to prevent the spread of drug-resistant bacteria in the hospital.

关 键 词：耐碳青霉烯类肠杆菌目细菌 耐消毒剂基因 消毒剂 最低抑菌浓度 

分 类 号：R181.32[医药卫生—流行病学]