碳青霉烯类药物耐药肠杆菌科细菌传播机制的研究

The mechanism of the transmission of carbapenem-resistant Enterobacteriaceae

目的研究大连医科大学附属一院2013-2014年期间收集的68株对碳青霉烯类药物耐药肠杆菌科细菌(CRE)的药敏结果、耐药基因携带情况及传播机制。方法采用WHONET 5.6软件分析菌株耐药情况;聚合酶链反应技术(PCR)检测KPC、IMP、VIM、ISCR1及ISCR1可变区;ERIC-PCR进行同源性分析。结果 2014年与2013年相比较,各类抗生素的耐药率差异虽没有统计学意义,但均有所升高,升高率大部分约为20%;68株CRE中,KPC阳性16株,占23.5%,IMP阳性2株,占2.9%,VIM阳性17株,占25.0%,ISCR1阳性37株,占54.4%,ISCR1可变区阳性21株,占30.9%;ERIC-PCR将45株碳青霉烯类耐药肺炎克雷菌分为4个型别(A^D):A型占64.5%,B型占13.3%,C型占8.9%,D型占13.3%;23株碳青霉烯类耐药大肠埃希菌分为3个型别(A^C):A型占60.9%,B型占30.4%,C型占8.7%。结论 ISCR1是耐药基因分子间水平传播的重要原因。

Objective To study the drug susceptibility,drug resistant genes and the mechanism of the transmission of 68 strains of carbapenem-resistant Enterobacteriaceae collected from 2013 to 2014in our hospital.Methods The drug resistance was analyzed by WHONET 5.6system;The KPC,IMP,VIM,ISCR1 and variable region of ISCR1 were identified by PCR.Enterobacterial repetitive intergenic consensus-PCR（ERIC-PCR）was performed to analyze the molecular epidemiology of the isolates.Results The rate of antibiotic resistance in 2014 increased by about 20% compared with that in 2013.Among the 68 strains of carbapenem-resistant Enterobacteriaceae,16 strains were KPC positive（23.5%）,2strains were IMP positive（2.9%）,17 strains were VIM positive（25.0%）,37 strains were ISCR1positive（54.4%）,and 21 strains were variable region of ISCR1positive（30.9%）.45 strains of KPN（resistant to carbapenem）were identified by ERIC-PCR as belong to 4genotypes,among which type A accounted for 64.5%,type B 13.3%,type C 8.9%,and type D 13.3%.23 strains of ECO were identified as belong to 3genotypes,among which type A accounted for 60.9%,type B 30.4%,and type C8.7%.Conclusion ISCR1 is the main reason of molecular transmission of the drug-resistant gene.