耐碳青霉烯类肠杆菌科细菌耐药基因分析

Drug Sensitivity and Resistance Gene of Carbapenem Resistant Enterobacteriaceae

目的对武汉大学中南医院耐碳青霉烯类肠杆菌科细菌(Carbapenem resistant Enterobacteriaceae,CRE)进行耐药性及基因分析,为CRE感染提供依据。方法采用WHONET5.6软件对CRE菌株进行耐药分析;改良Hodge试验对53株CRE菌株采用亚胺培南、厄他培南和美洛培南三种药敏纸片进行表型筛选;对31株CRE进行耐药基因分析。结果53株CRE中,肺炎克雷伯菌34株占64.15%,大肠埃希菌12株占22.64%,阴沟肠杆菌7株占13.21%;Hodge试验阳性菌株有31株,占58.49%(31/53),亚胺培南、厄他培南和美罗培南三种药敏纸片的Hodge试验结果一致;31株CRE中,扩增出blaKPC基因的菌株有29株,占93.55%,blaNDM基因有9株,占29.03%,blaKPC和blaNDM两种基因同时含有的菌株是8株,占25.81%,未扩增出blaIMP,blaOXA和blaVIM耐药基因。结论 31株耐碳青霉烯类肠杆菌主要耐药机制携带KPC和NDM型碳青霉烯酶基因;重症医学科和呼吸内科病房检出的CRE主要是肺炎克雷伯菌,其耐药基因型主要是KPC型,干部病房CRE主要是大肠埃希菌,其耐药基因型主要是KPC和NDM的混合型。

Objective To analyze the resistance genes of carbapenem resistant Enterobacteriaceae（CRE）from Zhongnan Hospital of Wuhan University,so as to provide evidence for CRE infection.Methods WHONET 5.6 software was used to analyze the resistance of carbapenem resistant Enterobacteriaceaeisolated.Phenotype screening of 53 CRE strains taken with the modified Hodge test by three drug susceptibility slip to imipenem,meropenem and ertapenem,and analysed resistance gene analysis of 31 CRE strains phenotype screening.Results In 53 CRE strains,34 strains of Klebsiella pneumoniae,accounting for 64.15%,12 strains of Escherichia coli,accounting for 22.64%,7 strains of Enterobacter cloacae accounted for13.21%,and there were 31 strains of Hodge test positive strains,accounting for 58.49%（31/53）.The Hodge test results of three kinds of drug sensitive paper of imipenem,meropenem and ertapenem were consistent.In 31 strains of CRE,29 strains of blaKPC gene were amplified,accounting for 93.55%,9 strains of blaNDM gene,accounting for 29.03%,contained simaltaneous and two genes of blaKPC and blaNDM were 8 strains,accounting for 25.81%,the resistance genes of BlaIMP,blaOXA,and blaVIM were not amplified.Conclusion Resistance to carbapenems was mainly due to the production of KPC and NDM in Enterobacteriaceae of 31 strains.The CRE was detected in the Intensive Care Unit and Respiratory ward for mainly Klebsiella pneumoniae,and the main genotype was KPC.The CRE was detected in the Cadre ward mainly Escherichia coli,and the drug-resistant genotype was mainly a mixed type of KPC and NDM.