2021-2023年河南省某医院产碳青霉烯酶大肠埃希菌的分子流行特征分析  

Epidemiology analysis of carbapenemase-producing Escherichia coli in a hospital in Henan Province from 2021 to 2023

作　　者：胡玥[1] 刘心伟[2] 任彦颖 刘冬梅 刘玉春 夏晴 李永伟[1] 王春霞[3] Hu Yue;Liu Xinwei;Ren Yanying;Liu Dongmei;Liu Yuchun;Xia Qing;Li Yongwei;Wang Chunxia(Department of Medical Laboratory,Henan Province Hospital of Traditional Chinese Medicine,Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Drug-Resistant Bacterial Infections of Henan Province,Zhengzhou 450002,China;The Second Clinical Medical Faculty of Henan University of Chinese Medicine,Zhengzhou 450046,China;Department of Reproductive Medicine,Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou 450002,China)

机构地区：[1]河南省中医院检验中心,河南省防治耐药菌感染中医药重点实验室,郑州450002 [2]河南中医药大学第二临床医学院,郑州450046 [3]河南省中医院生殖医学科,郑州450002

出　　处：《中华预防医学杂志》2025年第1期53-61,共9页Chinese Journal of Preventive Medicine

基　　金：河南省中医药科学研究专项课题(2023ZY1011)。

摘　　要：目的对2021—2023年河南省某医院产碳青霉烯酶大肠埃希菌(Carbapenemase-prodcing Escherichia coli,CPECO)的耐药基因流行特征进行分析,为控制CPECO的院内传播感染提供数据支撑和理论依据。方法采用横断面研究,对2021—2023年河南省中医院临床微生物实验室经VITEK-2 Compact鉴定和药敏试验确认的30株碳青霉烯耐药的大肠埃希菌(CRECO),使用碳青霉烯酶抑制剂增强试验进行碳青霉烯酶初筛,胶体金免疫层析法和聚合酶链反应(PCR)法分别对常见碳青霉烯酶表型和基因型(bla_(KPC)、bla_(NDM)、bla_(VIM)、bla_(IMP)、bla_(OXA))进行确证,同时使用PCR法对常见超广谱β-内酰胺酶(ESBL)基因型(bla_(SHV)、bla_(TEM)、bla CTX)予以确证;对碳青霉烯酶和ESBL阳性菌株的PCR扩增产物进行Sanger测序,测序产物在Blast网站中进行比对,确定确切的碳青霉烯酶和ESBL基因型;采用Achtman多位点序列分型方案对CPECO进行序列分型(ST),确定不同菌株之间的克隆关系。结果共筛选出CPECO 21株;药敏试验结果显示,CPECO菌株呈现泛耐药性,对单环类(氨曲南)和甲氧苄啶/磺胺甲噁唑的耐药率在60%以上(16/21、14/21),其余抗菌药物的耐药率为100%。仅对氨基糖苷类药物和磷霉素保持相对较高的敏感性,未发现对替加环素和多黏菌素耐药的菌株。胶体金免疫层析法检出bla_(NDM)型18株,bla_(KPC)型2株,bla_(IMP)型1株;耐药基因PCR产物测序分型bla_(NDM)-5型17株,bla_(NDM)-4型1株,bla_(KPC)-2型2株,bla_(IMP)-4型1株,与筛选试验和胶体金免疫层析法结果完全吻合。ESBL耐药基因检测显示,bla_(TEM)检出率为42.9%(9/21),bla CTX-M为33.3%(7/21),bla_(SHV)为4.8%(1/21),产bla_(NDM)型CPECO同时携带两种ESBL耐药基因的比率为27.8%(5/18);MLST分型结果发现11种ST型,包括1个ST155复合群和9个独立型,其中ST167型7株,ST410型5株,ST58、ST68、ST69、ST93、ST131、ST155、ST648、ST1114和ST3268各1株。结论本研究CPECO主要耐�Objective To analyze the epidemiological characteristics of drug resistance genes of carbapenemase-producing Escherichia coli(CPECO)in Henan Province Hospital of Traditional Chinese Medicine from 2021 to 2023,providing data support and theoretical basis for controlling nosocomial infections of CPECO.Methods Using a cross-sectional study,30 carbapenem-resistant Escherichia coli(CRECO)strains confirmed by VITEK-2 Compact identification and drug sensitivity test in the Clinical Microbiology Laboratory of Henan Province Hospital of Traditional Chinese Medicine from 2021 to 2023 were tested,using carbapenemase inhibitor enhancement test to conduct preliminary screening of carbapenemases,and colloidal gold immunochromatography and polymerase chain reaction(PCR)were used to determine the phenotypes and genotypes of common carbapenemases(blaKPC,blaNDM,blaVIM,blaIMP,blaOXA)respectively,and the genotypes(blaSHV,blaTEM,blaCTX)of common extended Spectrum beta-lactamases(ESBL)were confirmed using PCR.The PCR amplification products of carbapenemase and ESBL positive strains were Sanger-sequenced,and the sequencing products were compared on the Blast website to determine the exact carbapenemase and ESBL genotypes.Sequence typing(ST)was performed on CPECO using the Achtman multi-locus sequence typing scheme to determine the cloning relationship between different strains.Results A total of 21 CPECO strains were screened.Drug sensitivity test results showed that CPECO strains showed widespread drug resistance,with the resistance rate to monocyclic(aztreonam)and trimethoprim/sulfamethoxazole being over 60%(16/21,14/21),and the resistance rate to other antibacterial drugs being 100%.Only the sensitivity to aminoglycosides and fosfomycin remained relatively high,and no strains resistant to tigecycline and colistin were found.Colloidal gold immunochromatography detected 18 blaNDM types,2 blaKPC types,and 1 blaIMP type.Sequencing of drug resistance gene PCR products classified 17 blaNDM-5 strains,1 blaNDM-4 strain,2 blaKPC-2 strain,and

关 键 词：大肠埃希菌 耐药基因 多位点序列分析 流行性 

分 类 号：R446.5[医药卫生—诊断学]