摘要
目的对224株耐碳青霉烯类肠杆菌目细菌(CRE)进行回顾调查,重点对其耐药基因型的检测及耐药机制进行分析,帮助临床医生采取针对性的有效治疗。方法回顾性分析224株CRE来自联勤保障部队第九〇〇医院在2021年1月至2022年1月所送检的标本。使用全自动微生物鉴定药敏仪对细菌进行分离鉴定以及药敏试验分析;并使用荧光定量PCR仪采取SYBR Green结合染料法来对菌株的DNA进行检测。结果CRE耐药率超过60%的抗菌药物有4种,为总数的55.56%;试验结果可见CRE对绝大部分的β-内酰胺类的抗生素的耐药率偏高,其中对亚胺培南的耐药率高达100%;对于头孢他啶等第三代头孢菌素类、头孢西丁等头孢霉素类以及头孢呋辛等二代头孢菌素药物耐药性在80.00%以上;相反,CBE对环丙沙星、庆大霉素、妥布霉素以及左氧氟沙星的耐药性较低。存在KPC基因的株数最多为86株,占总株数的38.39%;其次是存在NDM、IMP基因的株数,占总株数的25.00%(56/224)和28.13%(63/224);再者是存在OXA基因的株数,为20株,占总株数的8.93%;而本研究未发现存在VIM基因的株数。结论CRE对大部分的抗菌药物均有较强的耐药性,其中以携带KPC基因的株数为多数。临床医生在治疗中可根据其耐药机制以及耐药基因型对抗菌药物的选择及使用。
Objective To review 224 strains of carbapenem-resistant Enterobacterales(CRE)focusing on the detection of their drug resistance genotype and analysis of the drug resistance mechanism,and to help clinicians to take targeted and effective treatment.Methods A total of 224 CRE samples from the 900th Hospital of the Joint Logistic Support Force from January 2021 to January 2022 were analyzed retrospectively.The bacteria were isolated and identified using the automatic microbial identification apparatus as well as for drug sensitivity analysis.SYBR Green combined with dye method was used to detect the DNA of the strain by fluorescence quantitative polymerase chain reaction.Results There were four kinds of antibiotics with CRE resistance rate over 60%,accounting for 55.56%of the total.The test results show high resistance rate of CRE toβ-lactam antibiotics,especially to Imipenem almost 100%.The drug resistance of CRE to the third generation cephalosporins such as Ceftazidime,cephalosporins such as Cefoxitin,and second generation cephalosporins such as Cefuroxime was more than 80.00%.On the contrary,the drug resistance of CRE to Ciprofloxacin,Gentamycin,Tobramycin,and Levofloxacin was low.The strain with KPC gene was most(86),accounting for 38.39%,followed by NDM and IMP genes,accounting for 25.00%(56/224)and 28.13%(63/224).Then the strain with OXA gene was 20,accounting for 8.93%.However,this study did not find strains with VIM gene.Conclusion CRE show strong resistance to most antimicrobial agents,especially strains with KPC gene.Clinicians can select and use appropriate antibiotics according to their drug resistance mechanism and genotype during treatment.
作者
刘伊楚
柯雅妮
LIU Yichu;KE Yani(Clinical Laboratory,the 900th Hospital of the Joint Logistic Support Force,Fujian Province,Fuzhou350025,China)
出处
《中国当代医药》
CAS
2023年第5期152-155,共4页
China Modern Medicine
关键词
碳青霉烯类抗生素
肠杆菌
耐药机制
耐药基因型
Carbapenem antibiotics
Enterobacterales
Drug resistance mechanism
Drug resistance genotype
