摘要
目的探讨耐碳青霉烯类革兰阴性杆菌的临床耐药性及耐药基因bla KPC的分子特征。方法分析2017年1月-2018年12月某院临床检出的耐碳青霉烯类革兰阴性杆菌。通过WHONET 5.6软件对药物敏感试验数据进行统计分析,采用PCR检测碳青霉烯耐药基因bla KPC、bla NDM、bla IMP、bla VIM、bla OXA-48,对PCR阳性产物进行DNA测序,分析耐药基因的分子结构特点。结果共收集510株耐碳青霉烯类革兰阴性杆菌,其中耐碳青霉烯类肠杆菌科细菌(CRE)420株,耐碳青霉烯非肠杆菌科细菌90株。菌株主要来自重症监护病房(ICU)、神经外科和呼吸科,分别占60.8%、11.8%、5.3%;标本来自痰、脓性分泌物、静脉血、无菌中段尿,分别占66.9%、8.8%、8.2%、6.5%。耐碳青霉烯类革兰阴性杆菌对常用抗菌药物具有较高的耐药性。PCR结果显示,420株CRE中bla KPC、bla NDM、bla IMP的阳性率分别为54.3%(228/420)、1.2%(5/420)、1.4%(6/420),未检测出bla VIM和bla OXA-48基因,其中肺炎克雷伯菌、产气肠杆菌、大肠埃希菌分别占携带bla KPC CRE的83.8%、11.8%、2.6%;其他少见菌种中也检出bla KPC基因。非肠杆菌科细菌中仅有2株鲍曼不动杆菌检测出bla KPC。DNA测序结果显示,174株携带bla KPC的菌株中173株检测为bla KPC-2、1株检测为bla KPC-1。结论该地区耐碳青霉烯类革兰阴性菌以CRE为主,其中以携带bla KPC-2的肺炎克雷伯菌占绝对优势,其他菌株中也均有发现。提示临床需重点加强耐碳青霉烯类肺炎克雷伯菌的监测及预防,防控bla KPC的传播流行。
Objective To investigate the clinical drug resistance of carbapenem-resistant Gram-negative bacilli and molecular characteristics of drug resistance gene bla KPC.Methods Clinically isolated carbapenem-resistant Gram-negative bacilli in a hospital from January 2017 to December 2018 were analyzed.Antimicrobial susceptibility testing data were statistically analyzed by WHONET 5.6 software,carbapenem-resistant genes bla KPC,bla NDM,bla IMP,bla VIM,and bla OXA-48 were detected by polymerase chain reaction(PCR),PCR positive products were performed DNA sequence to analyze the molecular structure of drug resistance genes.Results A total of 510 strains of carbapenem-resistant Gram-negative bacilli were collected,including 420 strains of carbapenem-resistant Enterobacteriaceae(CRE)and 90 strains of carbapenem-resistant non-Enterobacteriaceae.Strains were mainly from intensive care unit(ICU),departments of neurosurgery and respiratory,accounting for 60.8%,11.8%and 5.3%respectively;specimens were from sputum,purulent secretion,venous blood,and sterile midstream urine,accounting for 66.9%,8.8%,8.2%and 6.5%respectively.Carbapenem-resistant Gram-negative bacilli were highly resistant to commonly used antimicrobial agents.PCR results showed that among 420 strains of CRE,positive rates of bla KPC,bla NDM,and bla IMP were 54.3%(228/420),1.2%(5/420),and 1.4%(6/420)respectively.bla VIM and bla OXA-48 genes were not found,Klebsiella pneumoniae,Enterobacter aerogenes,and Escherichia coli accounted for 83.8%,11.8%,and 2.6%of bla KPC-carrying CRE respectively;bla KPC was also detected in other rare strains.bla KPC was detected in only 2 strains of Acinetobacter baumannii in non-Enterobacteriaceae.DNA sequencing showed that among 174 strains carrying bla KPC,173 strains were found bla KPC-2 and 1 strain was found bla KPC-1.Conclusion CRE is the main Gram-negative bacteria resistant to carbapenems in this area,dominantly Klebsiella pneumoniae carrying bla KPC-2,and other strains are also found.It is suggested that the monitoring and preve
作者
王珍珍
赵战勤
常永超
王瑞丽
薛云
WANG Zhen-zhen;ZHAO Zhan-qin;CHANG Yong-chao;WANG Rui-li;XUE Yun(The First Affiliated Hospital,College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China;College of Medical Technology and Engineering,Henan University of Science and Technology,Luoyang 471003,China;Animal Science and Technology,Henan University of Science and Technology,Luoyang 471003,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2020年第10期857-863,共7页
Chinese Journal of Infection Control
基金
国家自然科学基金(U1704117、31302106)。
