肠杆菌科细菌mcr-1流行病学研究  

Epidemiological study on carriage of polymyxin-resistant gene mcr-1 in Enterobacteriaceae isolates

作　　者：钱娇[1] 王怡岚 洪加稳 秦佳佳 王丽莎 厉世笑[1] 许春燕[1] 毛稳 郑淑芳 张嵘[3] 余素飞[1] QIAN Jiao;WANG Yilan;HONG Jiawen;QIN Jiajia;WANG Lisa;LI Shixiao;XU Chunyan;MAO Wen;ZHENG Shufang;ZHANG Rong;YU Sufei(Department of Clinical Laboratory,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China;不详)

机构地区：[1]浙江省台州医院检验科,317000 [2]金华市人民医院检验科 [3]浙江大学医学院附属第二医院检验科

出　　处：《浙江医学》2024年第3期251-256,I0005,共7页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY1204)。

摘　　要：目的探讨临床常见肠杆菌科细菌携带质粒介导多黏菌素耐药基因(mcr-1)的情况,为医院感染防控提供依据。方法收集2018年1月至2022年3月浙江省台州医院临床分离得到的菌株共1980株,包括大肠埃希菌1400株,肺炎克雷伯菌580株。采用PCR检测mcr-1基因;利用微量肉汤稀释法和E-test法检测抗生素对mcr-1阳性菌株的最低抑菌浓度;采用接合试验检测mcr-1基因在可转移质粒上的位置;通过提取细菌DNA基因组进行全基因组测序,并对测序结果进行多位点序列分型、质粒Inc分型和耐药基因识别等分析。结果在1400株大肠埃希菌中,共检测出6株携带mcr-1,阳性率为0.43%;580株肺炎克雷伯菌,仅1株检出mcr-1,阳性率为0.17%。其中5株菌株接合试验成功。6株大肠埃希菌的ST型分别是ST648、ST95、ST359、ST602、ST453、ST156,肺炎克雷伯菌是ST25。质粒Inc分型结果显示不同菌株携带相同类型质粒,提示该类质粒可以在菌株间水平传播。耐药基因分析发现7株细菌均携带大量的耐药基因,其中1株大肠埃希菌和肺炎克雷伯菌同时携带mcr-1和碳青霉烯耐药基因。结论mcr-1在大肠埃希菌和肺炎克雷伯菌中的分离率相对较低,然而考虑到含有mcr-1的质粒在不同细菌之间水平传播的潜力,以及mcr-1与同一质粒内的多个耐药基因整合的能力,在临床环境中要加强对多重耐药菌的管理。Objective To investigate the carriage of polymyxin-resistant gene mobile colistin resistance(mcr-1)in clinical isolates of Enterobacteriaceae.Methods From January 2018 to March 2022,1400 non-duplicate Escherichia coli and 580 Klebsiella pneumonia clinical isolates were collected from Taizhou Hospital of Zhejiang Province.The mcr-1 gene in the Enterobacteriaceae isolates was detected by PCR.The minimum inhibitory concentration of antibiotics was determined by micro broth dilution and E-test in positive strains.The conjugation test was conducted to determine if the mcr-1 gene was on transferable plasmids.The bacterial DNA was sequenced by whole genome sequencing,analyzed for multilocus sequence typing and plasmid Inc typing,the resistance genes were identified.Results Among the 1400 strains of Escherichia coli,6 were found carrying mcr-1,with a positive rate of 0.43%.Only 1 out of 580 Klebsiella pneumonia strains tested positive,with a positive rate of 0.17%.One Escherichia coli strain demonstrated resistance to carbapenem antibiotics.Five of the six mcr-1 positive strains were successfully transferred by conjugation.MLST typing revealed that the 6 mcr-1 positive Escherichia coli strains belonged to different ST types,including ST648,ST95,ST359,ST602,ST453,and ST156,while for Klebsiella pneumonia strain it was ST25.Different strains were found to have the same type of plasmids,indicating the possibility of horizontal transfer of these plasmids amongst strains.Resistance gene analysis revealed that seven strains carried many resistance genes,with one Escherichia coli and one Klebsiella pneumonia strain possessing both mcr-1 and carbapenem-resistance genes.Conclusion The prevalence of mcr-1 in Escherichia coli and Klebsiella pneumoniae strains exhibits a relatively low isolation rate.Nevertheless,given the potential for horizontal transmission of plasmids containing mcr-1 across diverse bacterial species,as well as the ability of mcr-1 to integrate with multiple resistance genes within the same plasmid,it becomes imp

关 键 词：大肠埃希菌 多黏菌素 多黏菌素耐药基因 多重耐药 

分 类 号：R446.5[医药卫生—诊断学]