摘要
目的 分析质粒介导的喹诺酮耐药基因(PMQR)在耐碳青霉烯类肠杆菌科细菌(CRE)中的分布,探讨喹诺酮类药物的耐药机制。方法 收集2021年7月至2022年9月该院临床分离非重复的43株CRE菌株,采用全自动微生物分析系统进行菌株鉴定和药敏试验,聚合酶链反应(PCR)技术检测PMQR、碳青霉烯酶和β内酰胺酶耐药基因,进行CRE菌株的喹诺酮耐药机制分析。结果 31株耐碳青霉烯类大肠杆菌对喹诺酮类药物的耐药率为93.55%~96.77%。12株耐碳青霉烯类肺炎克雷伯菌对喹诺酮类药物的耐药率为66.67%~83.33%。43株CRE对β内酰胺酶阻滞剂类药物的耐药率均在79.07%~100.00%;对多黏菌素和替加环素100.00%敏感。对氨基糖苷类的阿米卡星和妥布霉素耐药率较低。43株CRE中,88.37%携带有1个或2个PMQR,其中acc(6′)Ib-cr检出率为83.72%,qnrS检出率为69.77%,qnrB检出率为2.33%,没有检测到qnrA和qepA。碳青霉烯酶耐药基因以NDM(88.97%)和KPC(32.56%)为主。β内酰胺酶耐药基因以SHV(83.23%)和CTX-M15(67.57%)为主。结论 PMQR在CRE菌株中的检出率很高,与CRE的喹诺酮类药物耐药机制有关,可能与NDM、KPC、CTX-M15共同作用导致多药耐药。
Objective To analyze the distribution of plasmid-mediated quinolone resistance gene(PMQR)in carbapenem-resistant enterobacteriaceae(CRE),and to explore the mechanism of quinolone resistance.Methods A total of 43 non-repetitive CRE strains isolated from the hospital from July 2021 to September 2022 were collected.The automatic microbial analysis system was used for strain identification and drug sensitivity test.The PMQR,carbapenemase andβ-lactamase resistance genes were detected by polymerase chain reaction(PCR),and the quinolone resistance mechanism of CRE strains was analyzed.Results The drug resistant rates of 31 strains of carbapenem-resistant escherichia coli to quinolones were 93.55%-96.77%.The drug resistant rates of 12 strains of carbapenem-resistant Klebsiella pneumoniae to quinolones were 66.67%-83.33%.The drug resistant rates of 43 CRE strains toβ-lactamase blockers were 79.07%-100.00%.It was 100.00%sensitive to polycolistin and tigacycline.The drug resistant rates of amikacin and tobramycin to polymyxin and tigecycline and aminoglycosides were low.Among the 43 CRE strains,88.37%carried one or two PMQRs,of which the detection rate of acc(6′)Ib-cr was 83.72%,the detection rate of qnrS was 69.77%,the detection rate of qnrB was 2.33%,and qnrA and qepA were not detected.Carbapenemase resistance genes were mainly NDM(88.97%)and KPC(32.56%).β-lactamase resistance genes were mainly SHV(83.23%)and CTX-M15(67.57%).Conclusion The detection rate of PMQR in CRE strains is high,which is related to the quinolone resistance mechanism of CRE,and may lead to multidrug resistance with the combined action of NDM,KPC and CTX-M15.
作者
冯霞
刘小云
许晶晶
FENG Xia;LIU Xiaoyun;XU Jingjing(Central Laboratory,Affiliated Hospital of Xuzhou Medical University,Jiangsu,Xuzhou 221002,China;Department of Clinical Laboratory,Affiliated Hospital of Xuzhou Medical University,Jiangsu,Xuzhou 221002,China)
出处
《现代医药卫生》
2023年第23期3977-3981,共5页
Journal of Modern Medicine & Health
