耐万古霉素肠球菌基因分型及耐药性分析

Genotype and analysis of drug resistance for vancomycin resistant enterococci

目的明确万古霉素耐药肠球菌(vancomycin resistant enterococci,VRE)耐药基因型别及耐药性,指导临床用药。方法收集北京中日友好医院2016年10月至2017年10月临床分离的17株VRE,Vitek 2 Compact全自动细菌鉴定及药敏分析系统检测其对临床常用14种抗菌药物的敏感性,E-test法确证其对万古霉素和替考拉宁的药物敏感性;PCR法检测17株VRE的耐药基因vanA、vanB、vanC1、vanC2/3,并经测序验证。结果 17株VRE均为耐万古霉素屎肠球菌,均对环丙沙星、左氧氟沙星、莫西沙星、青霉素100%耐药,对利奈唑胺、替加环素、奎奴普丁/达福普汀等敏感;其耐药基因型均为vanA型,其中有4株vanB表型-vanA基因型。结论所收集的VRE均对万古霉素高水平耐药,耐药型均为vanA型,应加强临床分离株的耐药监控,合理使用抗菌药物。

Objective To identify the genotype and drug resistance of vancomycin resistant enterococci(VRE) for guiding the clinical medication. Methods Seventeen VRE strains isolated from China-Japan Friendship Hospital from October 2016 to October 2017 were collected and identified, and the susceptibilities to fourteen commonly used antimicrobial drugs were detected by Vitek 2 Compact Automatic Bacterial Identification and Drug Sensitivity Analysis System. The sensitivities to vancomycin and teicoplanin were confirmed by E-test. The resistant gene vanA, vanB, vanC1 and vanC2/3 in the seventeen VRE strains were detected by PCR and the results were confirmed by sequencing. Results All the seventeen VRE strains were conformed to be vancomycin-resistant enterococcus and complete resistant to ciprofloxacin, levofloxacin, moxifloxacin, penicillin, but sensitive to linazolamine, tegicycline and quenuptine/dafostine, etc. The resistant genotype of the seventeen strains was all vanA, of which four were vanB phenotype-vanA genotype. Conclusion The VRE strains collected in this study were all highly resistant to vancomycin, and the drug resistant genotype was vanA, so the monitoring for drug resistance of clinical isolates and rational use of antibiotics should be strengthened.