肠杆菌目产碳青霉烯酶基因型分析  

Analysis of the carbapenemase genotypes in enterobacteriaceaes

作　　者：刘振嘉[1] 杨春霞[1] 毛熠 王鹏[1] 范欣 LIU Zhenjia;YANG Chunxia;MAO Yi;WANG Peng;FAN Xin(Department of Infection and Clinical Microbiology,Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital,Capital Medical University,Beijing,China,100020)

机构地区：[1]首都医科大学附属北京朝阳医院-北京市呼吸疾病研究所,感染和临床微生物科,北京100020

出　　处：《分子诊断与治疗杂志》2025年第2期362-365,共4页Journal of Molecular Diagnostics and Therapy

摘　　要：目的了解首都医科大学附属北京朝阳医院耐碳青霉烯类药物肠杆菌目细菌的菌种分布及其携带碳青霉烯酶基因的类型,为临床提供合理用药依据;验证检测碳青霉烯酶胶体金方法的特异性和敏感性。方法收集首都医科大学附属北京朝阳医院2019年1月至2020年12月临床标本中分离的碳青霉烯类耐药肠杆菌目细菌178株,分析其菌种分布,通过PCR和测序检测碳青霉烯酶基因亚型,并与碳青霉烯酶胶体金法检测结果比较两者的一致性。结果耐碳青霉烯类肠杆菌目细菌主要来源于下呼吸道标本,以肺炎克雷伯菌最为常见(77.53%)其次为大肠埃希菌(10.67%)和阴沟肠杆菌复合群(6.74%),耐药基因分型有blaKPC-2(78.09%)、blaNDM-1(6.48%)、blaNDM-5(10.67%)、blaIMP-4(1.12%)、blaIMP-26(1.69%)和blaOXA-23(0.56%)。肺炎克雷伯菌以产KPC-2型碳青霉烯酶为主,大肠埃希菌主要产NDM-5型碳青霉烯酶,而阴沟肠杆菌复合群主要产NDM-1和IMP-26。以PCR测序为金标准,检测碳青霉烯酶胶体金方法的敏感性为100%,特异性为99.26%。结论首都医科大学附属北京朝阳医院耐碳青霉烯类药物肠杆菌目细菌以产KPC、NDM和IMP型碳青霉烯酶为主要的耐药机制;胶体金方法可以快速准确地检测KPC和NDM两种碳青霉烯酶。Objective To investigate the distribution of carbapenem-resistant Enterobacteriaceae and the types of carbapenem genes,and provide basis for rational drug use in clinic;to verify the specificity and sensitivity of colloidal gold method for detecting carbapenemase.Methods A total of 178 strains of carbapenem-resistant Enterobacteriaceae were isolated from clinical specimens at Beijing Chao-yang Hospital Affiliated to Capital Medical University from January 2019 to December 2020 were collected.The distribution of the strains was analyzed,carbapenem gene subtypes were detected using PCR and sequencing,and the consistency between colloidal gold method and the gold standard was compared.Results Carbapenem-resistant Enterobacteriaceae mainly come from lower respiratory tract specimens,with Klebsiella pneumoniae being the most common(77.53%),followed by Escherichia coli(10.67%)and Enterobacter cloacae complex(6.74%).The genotypes identified were bla KPC-2(78.09%),bla NDM-1(6.48%),bla NDM-5(10.67%),bla IMP-4(1.12%)bla IMP-26(1.69%),and bla OXA-23(0.56%).Klebsiella pneumoniae mainly produces KPC-2 carbapenemase,Escherichia coli mainly produces NDM-5 carbapenemase,while Enterobacter cloacae complex mainly produces NDM-1 and IMP-26.When compared to PCR and sequencing,the colloidal gold method showed a sensitivity of 100%and specificity of 99.26%.Conclusion The resistance mechanism of carbapenem-resistant Enterobacteriaceae in Beijing Chao-Yang Hospital affiliated to Capital Medical University mainly involves the production of KPC,NDM,and IMP carbapenemase.The immunochromogenic method can quickly and accurately detect KPC and NDM.

关 键 词：肠杆菌目 碳青霉烯酶 基因分型 胶体金 

分 类 号：R446.5[医药卫生—诊断学]