青海省碳青霉烯类耐药肠杆菌目细菌的分子流行病学分析  

Molecular epidemiological analysis of carbapenem-resistant Enterobacterales in Qinghai Province

作　　者：何轶群[1] 扎拉加 李娟 董娟 卢天龙[1] 黄文辉[1] HE Yiqun;ZHA Lajia;LI Juan;DONG Juan;LU Tianlong;HUANG Wenhui(Department of Clinical Laboratory,Affiliated Hospital of Qinghai University,Xining,Qinghai 810001,China)

机构地区：[1]青海大学附属医院检验科,青海西宁810001

出　　处：《检验医学与临床》2024年第22期3352-3358,共7页Laboratory Medicine and Clinic

基　　金：青海大学附属医院中青年科研基金项目(ASRF-2021-YB-18);科技基础资源调查专项(2019FY101208)。

摘　　要：目的通过研究2022年7月至2023年5月青海省5家医院分离的碳青霉烯类耐药肠杆菌目细菌(CRE)的分布、基因型及耐药性,为临床CRE感染的治疗、院内感染防控,以及抗菌药物制订和评价提供数据支持。方法采用基质辅助激光解析电离飞行时间质谱仪进行细菌鉴定,采用VITEKⅡcompact进行细菌药敏试验,采用碳青霉烯酶抑制剂增强试验进行产酶表型鉴定,采用聚合酶链反应检测碳青霉烯酶基因(blaKPC、blaNDM、blaIMP、blaVIM和blaOXA-48)。对分离出的优势菌株进行多位点序列分型(MLST)和同源性分析。结果共分离出59株CRE,其中50株分离自临床标本,9株分离自患者所处的环境;59株CRE中阴沟肠杆菌23株,肺炎克雷伯菌22株,大肠埃希菌7株,产酸克雷伯菌5株,弗氏柠檬酸杆菌和布氏柠檬酸杆菌各1株。CRE主要分离于重症监护病房、烧伤科、肝胆科。标本来源主要为伤口分泌物、痰液、血液。59株CRE对酶抑制剂复合制剂、头孢菌素类、氨曲南及碳青霉烯类等抗菌药物均具有较高的耐药率(87.5%~100.0%),对阿米卡星和替加环素的耐药率相对较低,分别为30.4%和15.5%。最常见的碳青霉烯酶基因型是blaNDM(59.32%,35/59),其次是blaKPC(32.20%,19/59),肺炎克雷伯菌中blaKPC-2检出率最高(72.73%,16/22),阴沟肠杆菌中blaNDM-1检出率最高(69.57%,16/23)。MLST结果显示,肺炎克雷伯菌ST分型主要为ST11型(68.18%,15/22),阴沟肠杆菌ST分型主要为ST97型(26.09%,6/23),9株从患者所处环境中分离出的CRE与临床菌株的ST型一致。结论青海省5家医院分离的CRE耐药率普遍较高,主要以阴沟肠杆菌和肺炎克雷伯菌为主,碳青霉烯酶基因以blaNDM和blaKPC为主,耐药问题严重,临床应加强CRE的筛查及控制,预防其在院内传播。Objective To study the distribution,genotype and drug resistance of carbapenem-resistant Enterobacterales(CRE)isolated from five hospitals in Qinghai province from July 2022 to May 2023,so as to provide data support for the treatment of clinical CRE infection,the prevention and control of nosocomial infection,as well as the development and evaluation of antibiotics.Methods Matrix-coenzyme laser desorption ionization time-of-flight mass spectrometry was used for bacterial identification,and VITEKⅡcompact was used for bacterial susceptibility test.Carbapenemase-producing phenotype was identified by carbapenemase inhibitor enhancement test.Carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM and blaOXA-48)were detected by polymerase chain reaction.Multilocus sequence typing(MLST)and homology analysis were performed on the isolated dominant strains.Results A total of 59 CRE strains were isolated,of which 50 strains were isolated from clinical specimens and 9 strains were isolated from patients′environment.Among the 59 CRE strains,there were 23 strains of Enterobacter cloacae,22 strains of Klebsiella pneumoniae,7 strains of Escherichia coli,5 strains of Klebsiella oxytoca,1 strain of Citrobacter freundii and 1 strain of Citrobacter brucei.CRE were mainly isolated from intensive care units,departments of burn and department of hepatobiliary.The main sources of specimens were wound secretion,sputum and blood.The 59 CRE strains had high resistance rates to enzyme inhibitor compound,cephalosporins,aztreonam and carbapenems(87.5%-100.0%),and relatively low resistance rates to amikacin and tigecycline,which were 30.4%and 15.5%respectively.The most common carbapenemase genotype was blaNDM(59.32%,35/59),followed by blaKPC(32.20%,19/59).The detection rate of blakPC-2 was the highest in Klebsiella pneumoniae(72.73%,16/22),and blandM-1 was the highest in Enterobacter cloacae(69.57%,16/23).The results of MLST showed that the ST type of Klebsiella pneumoniae was mainly ST11(68.18%,15/22),and the ST type of Enterobacter cloacae was

关 键 词：碳青霉烯耐药肠杆菌目细菌 耐药性 基因型 碳青霉烯酶 阴沟肠杆菌 肺炎克雷伯菌 

分 类 号：R446.5[医药卫生—诊断学]