南昌地区2021—2022年碳青霉烯类肠杆菌目细菌分布及耐药特征  

Distribution and drug resistance characteristics of carbapenem-resistant Enterobacterales in Nanchang area from 2021 to 2022

作　　者：俞凤 蒋沁炆 胡龙华[3] 金桂林 袁方 YU Feng;JIANG Qinwen;HU Longhua;JIN Guilin;YUAN Fang(The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang,Jiangxi 330006,China;The Third People's Hospital of Nanchang,Nanchang,Jiangxi 330009,China;The Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330006,China)

机构地区：[1]江西中医药大学附属医院,江西南昌330006 [2]南昌市第三人民医院,江西南昌330009 [3]南昌大学第二附属医院,江西南昌330006

出　　处：《中国热带医学》2024年第12期1439-1444,1523,共7页China Tropical Medicine

基　　金：江西省卫生健康委科技计划项目(No.202210796)

摘　　要：目的 分析产不同碳青霉烯酶肠杆菌目细菌(carbapenem-resistant Enterobacteriaceae,CRE)对抗菌药物的敏感性,及不同碳青霉烯酶检测方法学的比较,为临床应对CRE的抗感染治疗提供参考依据。方法 收集2021年1月—2022年8月江西省南昌市某三甲医院临床样本中分离的CRE菌株88株,采用MALDI-TOF MS进行菌种鉴定及Vitek2-compact检测其对常用抗菌药物敏感性,用肉汤微量稀释法检测头孢他啶/阿维巴坦和多黏菌素B对CRE的敏感性。碳青霉烯酶抑制剂增强试验筛查其碳青霉烯酶表型,聚合酶链反应(polymerase chain reaction,PCR)方法检测5种碳青霉烯酶耐药基因:肺炎克雷伯菌碳青霉烯酶(Klebsiella pneumoniae carbapenemases,bla_(KPC))、新德里金属-β-内酰胺酶(New Delhi metallo-beta-lactamase-1,bla_(NDM))、亚胺培南水解β-内酰胺酶(Imipenem hydrolyzing β-lactamase,bla_(IMP))、维罗纳整合子编码的金属内酰胺酶(metal β-lactamase of Verona integron,bla_(VIM))及苯唑西林水解碳青霉烯酶(oxacillin-hydrolyzing carbapenemase,blaOXA-48-like)基因,比较碳青霉烯酶表型与基因结果的一致性。结果 CRE感染患者主要以男性为主(58例),年龄(63.4±14.2)岁,主要分布于神经外科(26.1%,23/88)、重症监护室(17.0%,15/88)和康复科(15.9%,14/88)。阳性标本来源主要为呼吸道分泌物(60.2%,53/88)、尿液(21.6%,19/88)和血液(5.7%,5/88)。药敏试验结果显示,CRE对头孢菌素及哌拉西林/他唑巴坦耐药率最高,达95%以上,对替加环素及多黏菌素B的耐药率最低,分别为4.5%(4/88)和1.1%(1/88)。碳青霉烯酶表型检测结果显示,产A类丝氨酸酶、B类金属酶和同时产A类与B类碳青霉烯酶菌株分别占69.4%(61/88)、28.4%(25/88)和1.1%(1/88)。PCR扩增碳青霉烯酶基因结果显示,携带A类耐药基因bla_(KPC)、携带B类耐药基因bla_(NDM)或bla_(IMP)、同时携带bla_(KPC+NDM)分别占70.5%(62/88)、28.4%(25/88)和1.1%(1/88),与酶表型结果一致率较高。单Objective To analyze the sensitivity of carbapenem-resistant Enterobacteriaceae(CRE)producing different carbapenemases to antibacterial drugs,compare various detection methods of carbapenemases,and provide a technical basis for the clinical anti-infective treatment of CRE.Methods A total of 88 CRE strains isolated from clinical samples in a hospital in Nanchang,Jiangxi Province,from January 2021 to August 2022 were collected.MALDI-TOF MS was used for strain identification and Vitek 2-compact was used to detect their susceptibility to commonly used antibacterial drugs.The susceptibility of ceftazidime/avibactam and polymyxin B to CRE was detected by the broth microdilution method.The carbapenemase inhibitor enhancement test(EDTA-APB)was employed to screen for carbapenemase phenotypes,while polymerase chain reaction(PCR)method was used to detect five carbapenemase resistance genes:Klebsiella pneumoniae carbapenemases(bla_(KPC)),New Delhi metallo-beta-lactamase-1(bla_(NDM)),Imipenem hydrolyzingβ-lactamase(bla_(IMP)),Metalβ-lactamase of Verona integron(blaVIM),and Oxacillin-hydrolyzing carbapenemase(blaOXA-48-like).The consistency between carbapenemase phenotypes and gene results was compared.Results CRE infection was predominantly found in males(58 cases),with an average age of(63.4±14.2)years,mainly distributed in neurosurgery(26.1%,23/88),the intensive care unit(17.0%,15/88),and the rehabilitation department(15.9%,14/88).The main sources of positive specimens were respiratory secretions(60.2%,53/88),urine(21.6%,19/88),and blood(5.7%,5/88).The results of the drug susceptibility test showed that CRE had the highest resistance rate to cephalosporins and piperacillin/tazobactam,exceeding 95%,and the lowest resistance rate to tigecycline and polymyxin B,at 4.5%(4/88)and 1.1%(1/88),respectively.The results of the carbapenemase phenotype detection showed that the strains producing class A serine enzymes,class B metalloenzymes,and both class A and B carbapenemases accounted for 69.4%(61/88),28.4%(25/88),and 1.1%(1/88),

关 键 词：碳青霉烯类耐药肠杆菌目细菌 酶抑制剂增强试验 头孢他啶/阿维巴坦 肺炎克雷伯菌碳青霉烯酶耐药基因 

分 类 号：R378[医药卫生—病原生物学]