肠杆菌科细菌在肿瘤患者胃肠道中的动态定植及耐碳青霉烯类肠杆菌科细菌引起的血流感染  

Dynamic colonization of Enterobacteriaceae in the gastrointestinal tract of tumor patients and bloodstream infections caused by carbapenem-resistant Enterobacteriaceae

作　　者：程国平[1] 王登奎 王庆丰 Guoping Cheng;Dengkiu Wang;Qingfeng Wang(Laboratory Department,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Luoyang Orthopedic Hospital of Henan Province(Henan Orthopedic Hospital),Luoyang 471002,China)

机构地区：[1]河南科技大学第一附属医院检验科,河南省洛阳市471003 [2]河南省洛阳正骨医院,河南省骨科医院

出　　处：《中国肿瘤临床》2025年第1期12-15,共4页Chinese Journal of Clinical Oncology

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20230474)资助。

摘　　要：目的:主动筛查肿瘤患者胃肠道中肠杆菌科细菌的动态定植情况,探索血流感染的肿瘤患者胃肠道中定植的碳青霉烯类耐药肠杆菌(carbapenem-resistant Enterobacteriaceae,CRE)与引发血流感染的细菌之间的同源性关系,为临床医师的诊疗提供有意义的参考依据。方法:针对2021年12月至2022年11月期间本院住院的肿瘤患者353份肠道标本中筛出的32株革兰阴性杆菌进行研究,细菌鉴定仪VITEK 2 Compact、碳青霉烯酶检测试剂盒(胶体金免疫层析法)及PCR方法检测其耐药表型与耐药基因。采用脉冲电场凝胶电泳(PFGE)分析比较患者肠道中CRE菌株与引起血流感染的病原微生物之间的同源性。结果:从肿瘤患者胃肠道中筛选出的32株革兰阴性杆菌中,耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKp)占1.6%(6/353),均携带blaKPC基因;CRE占比3.3%(12/353)。2例肠道定植肺炎克雷伯菌的患者发生血流感染,血流感染由与肠道定植菌相同的CRKp菌株引起。结论:肿瘤患者CRE肠道定植比例不高,但在某些情况下,定植于肿瘤患者肠道内的CRE可引起机体其他部位的异位感染,包括血流,应密切监测。对多次住院且住院时间长的危重患者应加强关注,早期筛查肠道定植微生物,合理规范抗生素使用。Objective:To actively screen the dynamic colonization of Enterobacteriaceae in the gastrointestinal tract of tumor patients and explore the homology between carbapenem-resistant Enterobacteriaceae(CRE)colonized in the gastrointestinal tracts of these patients and the bacteria causing bloodstream infections,to provide meaningful reference data for diagnosis and treatment by clinicians.Methods:A total of 32 strains of gram-negative bacilli were isolated from 353 intestinal specimens of tumor patients at The First Affiliated Hospital of Henan University of Science and Technology from December 2021 to November 2022.The bacterial identification instruments VITEK 2 Compact,a carbapenemase detection kit using colloidal gold immunochromatography,and polymerase chain reaction(PCR)were used to detectdrug resistance genes and phenotypes.Pulsed-field gel electrophoresis(PFGE)was used to analyze and compare the homology between CRE strains in the intestinal tract of patients and pathogenic microorganisms causing bloodstream infections.Results:Among the 32 strains of Gram-negative bacilli screened from the gastrointestinal tract of cancer patients,6 strains(1.6%,6/353)were carbapenem-resistant Klebsiella pneumoniae(CRKp).All six CRKp strains harbored blaKPC gene.The proportion of CRE is 3.3%(12/353).Bloodstream infection occurred in 2 patients with intestinal colonization of Klebsiella pneumoniae,which was caused by the same CRKp strain as intestinal colonization.Conclusions:The proportion of CRE intestinal colonization in tumor patients was not high;however,under certain circumstances,CRE colonized in the intestines of tumor patients can cause ectopic infections else where in the body,including the bloodstream,which should be closely monitored.The findings indicate the importance of increased attention to critically ill patients who have undergone multiple hospitalizations with long hospitalization times,as well as early screening for intestine-colonizing microorganisms and rational regulation of the antibiotic usage.

关 键 词：细菌异位 碳青霉烯类耐药的肠杆菌科细菌 碳青霉烯类耐药的肺炎克雷伯菌 同源性 

分 类 号：R730.43[医药卫生—肿瘤]