摘要
目的探讨表达不同碳青霉烯酶的耐碳青霉烯类肠杆菌科细菌(CRE)治疗策略,为临床有效治疗CRE感染提供依据。方法回顾性分析我院2016年1月—2018年12月临床标本中分离的CRE的相关资料及药敏数据。复苏碳青霉烯耐药的肺炎克雷伯菌、大肠埃希菌和弗氏柠檬酸杆菌,PCR检测其携带的碳青霉烯耐药基因,并比较碳青霉烯酶表型试验与基因结果的一致性。采用肉汤稀释法检测替加环素和头孢他啶/阿维巴坦的敏感性,K-B法检测氨曲南和头孢他啶/阿维巴坦联合作用效果。结果CRE对常用抗生素具有较高的耐药性。128株CRE菌株均含碳青霉烯耐药基因,其中81株含bla_(KPC),37株含bla_(NDM),5株含bla_(IMP),5株同时含bla_(KPC)和bla_(NDM)。酶抑制剂增强试验能够准确检测各种碳青霉烯酶酶型。替加环素的敏感率为97.6%,头孢他啶/阿维巴坦对产丝氨酸酶菌株的敏感率为100%,而对产金属酶和双酶菌株无效。氨曲南和头孢他啶/阿维巴坦有协同作用,对产金属酶和双酶菌株有很强的抗菌活性。结论不同酶型CRE可考虑采用不同治疗策略,利用酶抑制剂增强试验确定酶型后,合理选择抗生素进行有效治疗。
Objective To investigate the therapeutic strategies against carbapenem resistant Enterobacteriaceae(CRE)expressing different carbapenemases,and provide evidence for clinical effective treatment of CRE infections.Methods A retrospective analysis was conducted on relevant information and drug sensitivity data of CRE isolated from January 2016 to December 2018.Carbapenem resistant Klebsiella pneumoniae,Escherichia coli,and Citrobacter freundii were subcultured.The carbapenem resistance genes were detected by PCR,and the consistency of the carbapenemase phenotypic assays and gene results were compared.The antibiotic susceptibility tests of tigecycline and ceftazidime/avibactam were performed by the broth microdilution method.The K-B method was used to detect the effects of aztreonam combined with ceftazidime/avibactam.Results CRE had high resistance to common antibiotics.All of the 128 CRE isolates contained carbapenem resistance genes,including 81 with bla_(KPC),37 with bla_(NDM),5 with bla_(IMP),and 5 with both bla_(KPC) and bla_(NDM).The carbapenemase inhibitor enhancement test could accurately detect various carbapenemases.The sensitivity of tigecycline was 97.6%.The sensitivity of ceftazidime/avibactam to serinase producing isolates was 100%,but it was not effective to isolates producing metallo-β-carbapenemases(MBLs)and double carbapenemases.Aztreonam had a synergistic effect with ceftazidime-avibactam,and had strong antibacterial activity against CRE producing MBLs and double carbapenemases.Conclusion Different therapeutic strategies should be considered for CRE producing distinct carbapenemases.The antibiotics should be reasonably selected for the effective treatment against CRE after the carbapenemases type was determined by the carbapenemase inhibitor enhancement test.
作者
任艳丽
王云英
蒋敏
张雨虹
王燕
孙滨
Ren Yan-li;Wang Yun-ying;Jiang Min;Zhang Yu-hong;Wang Yan;Sun Bin(Department of Laboratory Medicine,The Second Affi liated Hospital of Chongqing Medical University,Chongqing 400010)
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2021年第4期339-345,共7页
Chinese Journal of Antibiotics
基金
国家自然科学基金(No.81802062)
重庆市科委面上项目(No.cstc2017JcyjAX0065)
重庆市教委研究项目(No.KJQN201800402)。
关键词
耐碳青霉烯类肠杆菌科细菌
碳青霉烯酶
表型检测
联合药敏
治疗策略
Carbapenem resistant Enterobacteriaceae
Carbapenemases
Phenotypic assay
Combined drug sensitivity
Treatment strategy
