某医院2020-2021年CRE耐药性及碳青霉烯酶基因分析  

Analysis of drug resistance and carbapenemase gene of carbapenem-resistant Enterobacteriaceae in a hospital from 2020 to 2021

作　　者：刘志武[1] 张甜甜 徐腾飞[1] 陈琳[3] Liu Zhiwu;Zhang Tiantian;Xu Tengfei;Chen Lin(Department of Clinical Medical Laboratory,the First Hospital of Lanzhou University,Lanzhou 730000;The First School of Clinical Medicine,Lanzhou 730000;Department of Infectious Disease,the First Hospital ofLanzhouUniversity,Lanzhou 730000)

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

出　　处：《中国抗生素杂志》2023年第7期806-812,共7页Chinese Journal of Antibiotics

基　　金：甘肃省自然科学基金(No.21JR1RA082)。

摘　　要：目的分析该院近2年住院患者耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)的临床特征、耐药性及碳青霉烯酶基因型特点,为临床有效抗感染治疗及院感防控提供依据。方法回顾性分析兰州大学第一医院2020年1月—2021年12月临床分离CRE327株。采用全自动时间飞行质谱检测系统(VITEK MS)及全自动细菌鉴定药敏分析仪(VITEK 2 Compact)进行菌株鉴定及药敏试验,药敏结果依据CLSI M100-S31判读;PCR方法检测bla_(KPC)、bla_(NDM)、bla_(IMP)、bla_(VIM)和bla_(OXA-48)5种碳青霉烯酶耐药基因。结果2020年1月—2021年12月我院临床标本中分离出327株CRE,主要为肺炎克雷伯菌70.64%(231/327),其次为阴沟肠杆菌17.13%(56/327)和大肠埃希菌6.73%(22/327);标本来源为痰50.76%(166/327)、血液13.15%(43/327)、分泌物10.09%(33/327)及尿液8.26%(27/327)等;科室分布主要是重症监护室41.9%(137/327)、儿科23.24%(76/327)及普外科14.37%(47/327)等。327株CRE对阿米卡星、庆大霉素、四环素、复方磺胺甲恶唑、左氧氟沙星和氨曲南耐药率分别是46.2%、61.80%、71.90%、74.60%、79.00%和81.4%。327株CRE中有317株(96.94%)检测到本研究关注的碳青霉烯酶耐药基因,其中168株菌携带bla_(KPC-2)基因(肺炎克雷伯菌124株、阴沟肠杆菌27株、大肠埃希菌10株、产酸克雷伯菌4株、弗劳地柠檬酸杆菌3株);107株携带bla_(NDM-1)基因(肺炎克雷伯菌75株、阴沟肠杆菌14株、大肠埃希菌11株、产酸克雷伯菌7株);42株携带bla_(NDM-5)基因(肺炎克雷伯菌25株、阴沟肠杆菌15株、弗劳地柠檬酸杆菌1株、奇异变形杆菌1株);7株菌携带bla_(IMP-4)基因(肺炎克雷伯菌3株,同时携带bla_(NDM-1)基因,阴沟肠杆菌4株,同时携带bla_(NDM-5)基因)。未检出bla_(OXA-48)和bla_(VIM)基因。结论该院近两年对临床常用抗菌药物耐药形势严峻,CRE菌株以携带bla_(KPC-2)和bla_(NDM-1)基因为主,应加强碳青霉烯类抗菌药物�Objective The clinical characteristics,drug resistance and carbapenemase genotype of carbapenemresistant Enterobacteriaceae(CRE)in hospitalized patients in the past two years were analyzed to provide evidence for effective clinical anti-infection treatment and nosocomial infection prevention and control.Methods Analyze retrospectively 327 CRE isolates from the First Hospital of Lanzhou University from January 2020 to December 2021 were analyzed retrospectively.Strain identification and drug sensitivity test were carried out by VITEK MS and VITEK 2 Compact.The drug sensitivity results were interpreted according to CLSI M100-S31.PCR was used to detect five carbapenemase resistance genes,including bla_(KPC),bla_(NDM),bla_(IMP),bla_(VIM) and bla_(OXA-48).Results A total of 327 CRE strains were isolated from clinical specimens in our hospital from January 2020 to December 2021.The 327 CRE strains were mainly Klebsiella pneumoniae(70.64%,231/327),followed by Enterobacter cloacae(17.13%,56/327)and Escherichia coli(6.73%,22/327).50.76%(166/327),13.15%(43/327),10.09%(33/327)and 8.26%(27/327)were from sputum,blood,secretions and urine,respectively.41.9%(137/327),23.24%(76/327)and 14.37%(47/327)were from the intensive care unit,pediatrics and general surgery.The drug resistance rates of 327 CRE strains to amicacin,gentamicin,tetracycline,cotrimoxazole,levofloxacin and amtronam were 46.2%,61.80%,71.90%,74.60%,79.00%and 81.4%,respectively.Among the 327 CRE strains,317 strains(96.94%)containing carbapenase resistance genes in this study were detected.168 strains carried bla_(KPC-2)(124 strains of Klebsiella pneumoniae,27 strains of Enterobacter cloacae,10 strains of Escherichia coli,4 strains of Klebsiella acidophilus and 3 strains of Fraudiella citrate);107 strains carried bla_(NDM-1)(75 strains of Klebsiella pneumoniae,14 strains of Enterobacter cloacis,11 strains of Escherichia coli and 7 strains of Klebsiella acidophilus);42 strains carried bla_(NDM-5)(25 strains of Klebsiella pneumoniae,15 strains of Enterobacter cloacis,

关 键 词：耐碳青霉烯类肠杆菌科细菌 耐药性 耐药基因 流行特征 

分 类 号：R978.1[医药卫生—药品]