碳青霉烯耐药肠杆菌目细菌分布特点及耐药基因分析  

An Analysis of Distribution Characteristics and Resistance Gene of Carbapenem Resistant Enterobacteriaceae

作　　者：万会林 孔燕 诸君 王小梅 孔德华 WAN Huilin;KONG Yan;ZHU Jun;WANG Xiaomei;KONG Dehua(Clinical Laboratory,Nanjing Gaochun People’s Hospital,Nanjing 211300,China)

机构地区：[1]南京市高淳人民医院检验科,江苏南京211300

出　　处：《标记免疫分析与临床》2025年第2期321-325,共5页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金资助项目(编号:81902124)。

摘　　要：目的了解本院耐碳青霉烯类肠杆菌目细菌(CRE)的分布特点及对常用抗菌药物的耐药情况,并进行耐药基因的分析。方法收集2019年1月至2023年12月本院分离的168株CRE菌株,采用Vitek2 Compact全自动细菌鉴定药敏分析系统(法国生物梅里埃公司)予以菌种鉴定及药敏试验,汇总CRE的菌种、标本来源、科室分布及耐药结果。同时,通过实时荧光PCR法测定CRE的耐药基因。结果168株CRE在种类分布上,以肺炎克雷伯菌(48.81%)、大肠埃希菌(30.95%)为主。标本来源分布上,以痰液(35.71%)、尿液(26.19%)和分泌物/脓液(15.48%)为主。科室分布上,以重症监护室(30.95%)、康复科(17.86%)为主。主要CRE对青霉素类、头孢菌素类、碳青霉烯类、喹诺酮类、单环β-内酰胺类、磺胺类抗菌药物普遍耐药,其中对碳青霉烯类抗菌药物的耐药率超过80%,对青霉素类、头孢菌素类抗菌药物的耐药率超过70%,对单环β-内酰胺类抗菌药物的耐药率超过60%。主要CRE对阿米卡星的耐药率在30%以下,对替加环素的耐药率在5%以下。CRE耐药基因以KPC基因(38.10%)和NDM基因(30.36%)为主。结论本院CRE菌种主要为肺炎克雷伯菌、大肠埃希菌,耐药基因主要为KPC、NDM基因,具有多重耐药性。临床应做好耐药监测,选择适宜的药物予以治疗。Objective To better understand the distribution characteristics of carbapenem resistant Enterobacteriaceae(CRE)and their resistance to commonly used antibiotics in our hospital,and to further identify the resistance genes.Methods From January,2019 to December,2023,168 strains of CRE isolated in our hospital were collected,and strain identification and drug susceptibility test were performed by Vitek2 Compact automatic bacterial identification and drug susceptibility analysis system(BioMérieux Corporate,France).The data of strain,specimen source,department distribution and drug resistance results of CRE were collected and summarized.In addition,the drug resistance genes of CRE were identified by real-time fluorescence PCR.Results In terms of species distribution,168 strains of CRE were mainly Klebsiella pneumoniae(48.81%)and Escherichia coli(30.95%).In terms of specimen source distribution,sputum(35.71%),urine(26.19%),and secretions/pus(15.48%)were the main sources.The distribution of departments was mainly in the Intensive Care Unit(30.95%)and Rehabilitation Department(17.86%).The main CRE strains were generally resistant to penicillin,cephalosporins,carbapenems,quinolones,monocyclicβ-lactam,and sulfonamide antibiotics,with a resistance rate of over 80%to carbapenem antibiotics,over 70%to penicillin and cephalosporin antibiotics,and over 60%to monocyclicβ-lactam antibiotics.The resistance rate of the main CRE strains to amikacin was below 30%,and the resistance rate to tigecycline was below 5%.The CRE resistance genes were mainly KPC genes(38.10%)and NDM genes(30.36%).Conclusion The main CRE strains in our hospital are Klebsiella pneumoniae and Escherichia coli,and the resistance genes are mainly KPC and NDM genes,which show multiple drug resistances.An efficient drug resistance monitoring program should be developed and carried out in clinical practice.Furthermore,appropriate drugs should be selected for treatments.

关 键 词：碳青霉烯 肠杆菌目细菌 分布特点 耐药基因 

分 类 号：R378[医药卫生—病原生物学]