耐碳青霉烯类肠杆菌血流感染患者耐药基因分析  

Analysis of drug resistance genes in patients with carbapenem-resistant Enterobacteriaceae intestinalis bloodstream infections

作　　者：邢康齐 薛庆节 石继魁[3] XING Kangqi;XUE Qingjie;SHI Jikui(College of Clinical Medicine,Jining Medical University,Jining,Shandong 272000,China;College of Basic Medicine,Jining Medical University,Jining,Shandong 272000,China;Department of Critical Medicine,Jining First People′s Hospital,Jining,Shandong 272000,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272000 [2]济宁医学院基础医学院,山东济宁272000 [3]山东省济宁市第一人民医院重症医学科,山东济宁272000

出　　处：《检验医学与临床》2024年第16期2400-2405,共6页Laboratory Medicine and Clinic

基　　金：山东省重点研发计划项目(2018GSF118137);山东省医药卫生科技项目(202319010449);山东省济宁市重点研发计划项目(2023YXNS106)。

摘　　要：目的 调查耐碳青霉烯类肠杆菌目细菌血流感染(CRE-BSI)的临床科室分布及耐药情况,分析其耐药基因型、毒力因子,以指导临床诊疗中抗菌药物的合理使用,预防耐药菌株的传播。方法 收集2021—2022年济宁市第一人民医院分离的21株临床CRE-BSI菌株,分析菌株的药敏结果;检测菌株的碳青霉烯酶基因(KPC、OXA-48、VIM、IMP、NDM);提取菌株DNA,并进行多位点序列分型(MLST)。结果 21株CRE-BSI菌株中,12株源于重症医学科,除对替加环素、多黏菌素/黏菌素、阿米卡星、米诺环素敏感性较好,部分菌株抗菌药物耐药率为100.00%。21株菌株中,肺炎克雷伯菌10株,大肠埃希菌10株,均以bla_(NDM)为主要产酶基因型;MLST结果显示,肺炎克雷伯菌主要流行ST11,大肠埃希菌主要流行ST361、ST410。毒力因子均有不同数量的检出,其中iroN、fimH检出率最高,分别为100.00%(20/20)、85.00%(17/20)。结论 济宁市第一人民医院分离的临床CRE-BSI菌株肺炎克雷伯菌中bla_(KPC-2)为主要产酶基因,大肠埃希菌中bla_(NDM-5)为主要产酶基因型,可能存在克隆流行和水平传播,临床需加强抗菌药物应用的监管,预防CRE院内爆发。Objective To investigate the clinical department distribution and drug resistance of carbapenem-resistant Enterobacteriaceae bloodstream infection(CRE-BSI),and analyze the genotypes and virulence factors of drug resistance to guide the rational use of antibiotics in clinical diagnosis and treatment and prevent the spread of drug-resistant strains.Methods Twenty-one clinical CRE-BSI strains isolated from the First People′s Hospital of Jining City during 2021-2022 were collected,The carbapenemase genes(KPC,OXA-48,VIM,IMP and NDM)of the strains were detected,and the DNA of the strains was extracted and subjected to multilocus sequence typing(MLST).Results Among the 21 CRE-BSI strains,12 strains originated from the Department of Critical Care Medicine;except for better susceptibility to tigecycline,polymyxin,amikacin,minocycline,antimicrobial resistance rates of some strains were 100.00%.Among 21 strains,10 strains were Klebsiella pneumoniae,10 strains were Escherichia coli,and bla NDM was the major enzyme-producing genotype.MLST results showed that Klebsiella pneumoniae was mainly distributed in ST11,while Escherichia coli was mainly distributed in ST361 and ST410.The virulence factors were detected in varying quantities,among which the iroN an d fimH had the highest detection rates[100.00%(20/20),85.00%(17/20)].Conclusion The clinical CRE-BSI strains isolated from the First People′s Hospital of Jining City,with bla KPC-2 as the main enzyme-producing gene in Klebsiella pneumoniae and bla NDM-5 as the main enzyme-producing genotype in Escherichia coli,may have clonal epidemiology and horizontal transmission,and the clinic needs to strengthen the supervision of antimicrobial drug application to prevent the nosocomial outbreak of CRE.

关 键 词：耐碳青霉烯类肠杆菌目细菌 血流感染 耐药基因 多重耐药 多位点序列分型 毒力因子 

分 类 号：R446.5[医药卫生—诊断学]