丁胺卡那对产碳青霉烯酶肺炎克雷伯菌和大肠埃希菌不同基因型体外药物敏感研究  

A study on in vitro susceptibility of different genotypes of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli to Amikacin

作　　者：吴晓燕 李小四 范陈良 郁俊杰 李爱娟 沈梦丽 WU Xiao-yan;LI Xiao-si;FAN Chen-liang;YU Jun-jie;LI Ai-juan;SHEN Meng-li(Clinical Laboratory,the Second Hospital of Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴市第二医院检验科,浙江314000

出　　处：《中国卫生检验杂志》2023年第17期2080-2082,共3页Chinese Journal of Health Laboratory Technology

基　　金：浙江省医药卫生科技计划面上项目(2021KY1109);嘉兴市科技局民生科技创新专项(2021AD30104)。

摘　　要：目的 探讨产碳青霉烯酶肠杆菌(CPE)分离株对丁胺卡那体外药敏活性。方法 收集本院2019年—2022年临床分离的74株产碳青霉烯酶且携带不同耐药基因型的肺炎克雷伯菌和大肠埃希菌,采用微量肉汤稀释法测定丁胺卡那体外药敏活性;选取携带blaOXA-48型菌株通过二代测序平台对其进行全基因组测序(whole genome sequencing, WGS)检测其对氨基糖苷类耐药相关基因。结果 74株菌株对丁胺卡那耐药率为43.2%;对肺炎克雷伯菌、大肠埃希菌耐药率分别为52.9%和21.7%;在肺炎克雷伯菌中,blaOXA-48型对丁胺卡那耐药率为100.0%,携带blaKPC、blaNDM和blaKPC+NDM耐药率分别为15.8%、16.7%、0.0%;在大肠埃希菌中,携带blaKPC和blaNDM对丁胺卡那耐药率分别为50.0%和6.7%;携带blaNDM与blaKPC对丁胺卡那的耐药率分别为9.5%(2/21)与24.0%(6/25)。所有携带blaOXA-48型菌株经测序均携带Rmtf甲基化酶基因和AAC(6)-Ib氨基糖苷修辞酶基因。结论 CPE中携带blaNDM对丁胺卡那具有较高的体外药物活性;携带blaOXA-48型肺炎克雷伯菌对丁胺卡那具有较高水平的MIC值,且携带RmtF及AAC(6)-Ib耐药基因,值得临床关注。Objective This study aims to study the in vitro activity of carbapenemase-producing Enterobacterales to Amikacin. Methods A total of 74 carbapenemase-producing Klebsiella pneumoniae and Escherichia coli with different drug resistant genotypes were collected from our hospital from 2019 to 2022. The micro-broth dilution method was used to determine the in vitro drug susceptibility of Amikacin. Strains carrying blaOXA-48 were selected for whole genome sequencing(WGS) through the second-generation sequencing platform to detect genes related to aminoglycoside resistance. Results The resistance rate of 74 strains to Amikacin was 43.2%. The drug resistance rates of Klebsiella pneumoniae and Escherichia coli were 52.9% and 21.7%, respectively. In Klebsiella pneumoniae, the resistance rate of blaOXA-48 to Amikacin was 100.0%, while the resistance rates of blaKPC, blaNDM and blaKPC+NDM were 15.8%, 16.7% and 0.0%, respectively. In Escherichia coli, the resistance rates of blaKPC and blaNDM to Amikacin were 50.0% and 6.7%, respectively. The resistance rates of blaNDM and blaKPC to Amikacin were 9.5%(2/21) and 24.0%(6/25), respectively. All strains carrying blaOXA-48 were sequenced to carry Rmtf methylase gene and AAC(6)-Ib aminoglycoside rhetoric enzyme gene. Conclusion blaNDM in CPE has high in vitro drug susceptibility to Amikacin. Klebsiella pneumoniae carrying blaOXA-48 has a high MIC value for Amikacin, and carries RmtF and AAC(6)-Ib resistance genes, which is worthy of clinical attention.

关 键 词：碳青霉烯酶 耐药基因 丁胺卡那 全基因组测序 

分 类 号：R446.5[医药卫生—诊断学]