2017-2019年某院肠杆菌科细菌检出特征及耐药基因检测

Detection characteristics and drug resistance genes of Enterobacteriaceae bacteria in a hospital between 2017 to 2019

目的探讨天津市某三甲医院2017-2019年肠杆菌科细菌检出特征及耐药基因情况。方法选择天津市某医院2017年1月-2019年12月临床分离的肠杆菌科菌株共2526株,其中耐碳青霉烯类肠杆菌科细菌(CRE)菌株178株。采用全自动微生物鉴定系统及药敏试验分析肠杆菌科细菌的分布特点及耐药情况。采用聚合酶链式扩增反应(PCR)检测CRE菌常见耐药基因VIM、NDM、KPC、OXA-48。结果CRE在2017-2019年肠杆菌科细菌中检出率分别为7.52%、6.37%、7.21%;近三年肠杆菌科检出率最高的菌株为大肠埃希菌;肠杆菌科细菌在重症监护室、急诊内科、呼吸内科、老年病科及神经外科检出率较高,CRE检出率较高的科室是老年病科、重症监护室及呼吸内科;检出肠杆菌科细菌的标本来源中痰液、尿液、血液、肺泡灌洗液及脑脊液占比较高;大肠埃希菌对头孢唑林、氨苄西林、哌拉西林、头孢呋辛及头孢曲松耐药率较高。分离出的178株CRE菌株中有168株均检出携带碳青霉烯酶基因,共146株检出KPC基因,22株检出NDM基因,未检出OXA-48及VIM基因。结论该院分离的肠杆菌科细菌耐药形势较为严峻,检出菌以携带KPC基因的大肠埃希菌及肺炎克雷伯菌为主。

OBJECTIVE To discuss the detection characteristics of Enterobacteriaceae bacteria and the detection of drug resistance genes in a third-class hospital in Tianjin between 2017 to 2019.METHODS A total of 2526 strains of Enterobacteriaceae were isolated in Tianjin People’s Hospital from Jan 2017 to Dec 2019,including 178 strains of Carbapenem-resistant Enterobacteriaceae(CRE).The distribution characteristics and drug resistance of Enterobacteriaceae bacteria were analyzed by using an automatic microbial identification system and drug susceptibility experiments.Polymerase chain amplification reaction(PCR)was used to detect common drug resistance genes VIM,NDM,KPC,and OXA-48 in CRE bacteria.RESULTS The detection rates of CRE in Enterobacteriaceae from 2017 to 2019 were 7.52%,6.37%,and 7.21%respectively.The strain with the highest detection rate of Enterobacteriaceae bacteria in the past three years was Escherichia coli,which was highly detected in geriatrics department,intensive care unit and respiratory medicine department.Specimens such as putum,urine,blood,alveolar lavage fluid and cerebrospinal fluid were the main sources of Enterobacteriaceae detected.The isolated E.coli was highly resistant to cefazolin,ampicillin,piperacillin,cefuroxime and ceftriaxone.Of the 178 isolated CRE strains,168 strains were all detected to carry the carbapenase gene;a total of 146 strains were detected KPC gene,22 strains were detected NDM gene,and no OXA-48 and VIM genes were detected.CONCLUSION The drug resistance of Enterobacteriaceae isolated in this hospital was severe,and the strains of bacteria detected were mainly E.coli and Klebsiella pneumoniae carrying the KPC gene.