| 佘亚辉,韩媛媛,柴杰,等.203株耐碳青霉烯类肠杆菌科细菌临床分布特征及耐药基因型分析[J].安徽医药,2020,24(5):885-888. |
| 203株耐碳青霉烯类肠杆菌科细菌临床分布特征及耐药基因型分析 |
| Analysis of clinical distribution and drug resistance genotyping of 203 carbapenem enterobacteriaceae strains |
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| DOI：10.3969/j.issn.1009?6469.2020.05.009 |
| 中文关键词: 肠杆菌科 基因， MDR β内酰胺酶类 碳青霉烯酶 耐药基因 临床分布 |
| 英文关键词: Enterobacteriaceae Genes,MDR beta?Lactamases Carbapenemases Resistance gene Clinical distribution |
| 基金项目:国家自然科学基金( 81571528) |
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| 摘要点击次数: 2022 |
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| 中文摘要: |
| 目的探讨医院耐碳青霉烯类肠杆菌科细菌( CRE)的分布特征、耐药特点及耐药基因型，为临床 CRE感染治疗提供理论依据。方法收集 2016年 1月至 2018年 9月亳州市人民医院临床分离的 CRE菌株，应用 Vitek 2?Compact全自动微生物分析仪对细菌进行鉴定和药敏试验。采用荧光定量 PCR方法检测 5种耐药基因 KPC、IMP、VIM、NDM?1和 OXA?48在 CRE菌株中的表达。结果共分离 203株 CRE菌株，其中 2016年全年 CRE菌检出 46株，检出率为 0.59%(46/784 9)，2017年全年 CRE菌检出 84株，检出率为 0.93%(84/901 1)，2018年 1月至 9月 CRE菌检出 73株，检出率为 1.33%(73/547 3)；标本类型以痰液标本为主，占 71.43%(145/203)；临床科室分布以儿科为主，占 30.05%(61/203)；细菌种类以肺炎克雷伯菌为主，占 57.14%(116/203)。药敏结果提示 CRE对碳青霉烯类抗菌药物亚胺培南耐药率为 100.0%，对厄他培南的耐药率为 82.27%，对头孢唑林耐药率为95.07%，对喹诺酮类药物耐药率分别为左氧氟沙星 44.33%，环丙沙星 19.24%；对阿米卡星的敏感率最高，为 77.34%。203株 CRE菌株中 NDM?1基因扩增阳性的菌株有 78株，占 38.42%，KPC基因阳性共有 49株，占 24.14%；其中 NDM?1和 HPC同时阳性者 19例，占 9.36%；IMP基因阳性共有 56株，占 27.59%；OXA?48基因阳性共有 20株，占 9.85%；未扩增出 VIM耐药基因。结论 CRE菌耐药严重，耐药基因以 NDM?1为主，临床医生应加强耐药监测，合理选择抗菌药物。 |
| 英文摘要: |
| Objective To investigate the distribution，drug resistance and genotype of carbapenem?resistant enterobacteriaceae(CRE)in hospitals，and to provide theoretical basis for clinical treatment of CRE infection.Methods CRE strains collected from January 2016 to September 2018 were identified by Vitek 2?Compact automatic microbiological analyzer.The expression of five re?sistance genes KPC，IMP，VIM，NDM?1 and OXA?48 in CRE strain was detected by fluorescence quantitative PCR.Results A to? tal of 203 strains of CRE were isolated.Among them，46 strains of CRE were detected in 2016，the detection rate was 0.59%(46/ 7849)，84 strains were detected in 2017，the detection rate was 0.93%(84/9011)，and 73 strains were detected from January to September 2018，and the detection rate was 1.33%(73/5473).The specimen type was mainly sputum specimens，accounting for 71.43%(145/203).The clinical department was mainly pediatric，accounting for 30.05%(61/203)，the bacterial species were main? ly Klebsiella pneumoniae，accounting for 57.14%(116/203).The drug sensitivity results suggested that the resistance rate of CRE to the antimicrobial drug imipenem was 100.0%，the resistance rate to ertapenem was 82.27 %，and the resistance rate to cefazolin was 95.07 %.The drug resistance rate to levofloxacin and ciprofloxacin was 44.33% and 19.24% respectively，for the highest of which was amikacin，77.34%.Among the 203 CRE strains，78 strains were positive for NDM?1 gene amplification，accounting for 38.42%.49 strains were positive for KPC gene amplification，accounting for 24.14%.Among them，19 cases were NDM?1 and HPC positive at the same time，accounting for 9.36%.56 strains were positive for IMP gene，accounting for 27.59%.20 strains were posi? tive for OXA?48 genes，accounting for 9.85%.VIM resistance gene was not amplified.Conclusion The drug resistance of CRE bac? teria is severe，and NDM?1 is the main drug resistance gene.Clinicians should strengthen drug resistance monitoring and select anti?biotics reasonably. |
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