耐碳青霉烯类抗菌药物肠杆菌科细菌的耐药基因分析

Drug resistance genes in carbapenem-resistant Enterobacteriaceae

目的分析郑州大学第一附属医院耐碳青霉烯类抗菌药物肠杆菌科细菌耐药基因的携带和分布情况。方法采用Vitek 2 Compact全自动微生物分析系统筛选2014年6月—2015年12月临床分离的大肠埃希菌和肺炎克雷伯菌,根据美国临床实验室标准化协会(CLSI)2013年文件判读,排除重复分离菌株,选出对亚胺培南/美罗培南耐药菌株共29株;采用聚合酶链反应(PCR)对KPC、NDM、VIM、SPM、GIM、IMP、OXA23、OXA24、OXA51和OXA58等相关基因进行检测。结果在分离的29株耐药菌株中共检出KPC阳性11株,其中肺炎克雷伯菌10株、大肠埃希菌1株;检出NDM阳性7株,其中肺炎克雷伯菌3株、大肠埃希菌4株,并有2株检测出变异基因NDM-5。结论郑州大学第一附属医院耐碳青霉烯类抗菌药物肠杆菌科细菌的主要耐药机制为携带KPC和NDM型碳青霉烯酶基因。

Objective To investigate the drug resistance genes in carbapenem-resistant Enterobacteriaceae isolated from the First Af？liated Hospital of Zhengzhou University. Methods The clinical isolates of Escherichia coli and Klebsiella pneumoniae were collected from June 2014 to December 2015,and they were screened by Vitek 2 Compact automatic bacterium identi？cation system,according to the Clinical and Laboratory Standards Institute（CLSI） 2013. A total of 29 isolates being resistant to imipenem/meropenem were sorted out except repeated isolates. The encoding genes of KPC,NDM,VIM,SPM,GIM,IMP,OXA23,OXA24,OXA51 and OXA58 were analyzed by polymerase chain reaction（PCR）. Results Among the 29 isolates,there were 11 isolates of KPC positive（10 isolates of Klebsiella pneumoniae and 1 isolate of Escherichia coli）. A total of 7 isolates were NDM positive（3 isolates of Klebsiella pneumoniae and 4 isolates of Escherichia coli）,and 2 isolates were identi？ed as variant gene NDM-5. Conclusions Resistance to carbapenems is mainly due to the production of KPC and NDM in Enterobacteriaceae.