某院耐碳青霉烯类肠杆菌科细菌的临床特征及耐药基因分析

Clinical Characteristics and Drug Resistance Gene Analysis of Carbapenem Resistant Enterobacteriaceae in A Hospital

目的:探讨某院耐碳青霉烯类肠杆菌科细菌(carbapenem resistant enterobacteriaceae,CRE)的临床特征及耐药基因。方法:选取2019年1月-2021年12月莆田学院附属医院分离出的285株CRE。所有菌株进行细菌鉴定及药敏、改良碳青霉烯灭活(modified carbapenem inactivation method,mCIM)、乙二胺四乙酸(EDTA)mCIM(EDTA-carbapenem inactivation method,eCIM)试验及耐药基因检测。分析285株CRE菌株分布情况、标本来源、科室分布情况及耐药基因。并对肺炎克雷伯菌和大肠埃希菌进行耐药性分析。结果:285株CRE中主要为肺炎克雷伯菌和大肠埃希菌,占比分别为83.16%、8.42%。285株CRE标本主要来源于痰液、尿液、血液,占比分别为47.02%、23.86%、9.47%。285株CRE标本主要来源于ICU、呼吸科,占比分别为65.96%、15.79%。肺炎克雷伯菌和大肠埃希菌对头孢唑林、阿莫西林克拉维酸钾、头孢他啶、哌拉西林钠他唑巴坦、头孢曲松、头孢吡肟、氨苄西林钠舒巴坦钠、亚胺培南及美罗培南等耐药率达95.00%以上,对环丙沙星及左氧氟沙星等耐药率达90.00%以上,对替加环素较敏感。285株CRE中有268株检出耐药基因,经BLAST比对得出,209株携带Bla_(KPC-2)型基因,占比为73.33%,12株携带Bla_(KPC-19)型基因,占比为4.21%,26株携带Bla_(NDM-1)型基因,占比为9.12%,21株携带Bla_(NDM-5)型基因,占比为7.37%,CRE肺炎克雷伯菌主要携带Bla_(KPC-2)型基因,CRE大肠埃希菌主要携带Bla_(NDM-5)型基因。结论:CRE有高耐药性特点,且在临床分布较为广泛,来源较广,同时CRE以携带Bla_(KPC-2)型基因的肺炎克雷伯菌及Bla_(NDM-5)型基因的大肠埃希菌为主。

Objective:To investigate the clinical characteristics and drug resistance genes of carbapenem resistant Enterobacteriaceae(CRE)in a hospital.Method:A total of 285 CRE strains isolated from the Affiliated Hospital of Putian University from January 2019 to December 2021 were selected.All strains conducted bacterial identification and drug sensitivity,modified carbapenem inactivation method(mCIM),ethylenediamine tetraacetic acid(EDTA)mCIM(EDTA-carbapenem inactivation method,eCIM)test,and drug resistance gene detection.The distribution condition,the source of samples,the distribution condition of departments and drug resistance genes of 285 CRE strains were analyzed.The drug resistance of Klebsiella pneumoniae and Escherichia coli was analyzed.Result:Among the 285 CRE strains,Klebsiella pneumoniae and Escherichia coli were dominant,accounted for 83.16%,8.42%respectively.285 CRE strains samples were mainly from sputum,urine and blood,accounting for 47.02%,23.86%and 9.47%respectively.285 CRE strains samples were mainly from ICU and respiratory department,accounting for 65.96%,15.79%respectively.The drug resistance rates of Klebsiella pneumoniae and Escherichia coli for Cefazolin,Amoxicillin Clavulanate Potassium,Ceftazidime,Piperacillin Sodium and Tazobactam Sodium,Ceftriaxone,Cefepime,Ampicillin Sodium and Sulbactam Sodium,Imipenem and Meropenem were more than 95.00%,the drug resistance rates for Ciprofloxacin and Levofloxacin were more than 90.00%.They were sensitive to Tegacyclin.Among the 285 CRE strains,268 strains were found to have drug resistance genes.BLAST comparison showed that 209 strains carried Bla_(KPC-2) gene,accounting for 73.33%,12 strains carried Bla_(KPC-19) gene,accounting for 4.21%,26 strains carried Bla_(NDM-1) gene,accounting for 9.12%,21 strains carried Bla_(NDM-5) gene,accounting for 7.37%,CRE Klebsiella pneumoniae mainly carried Bla_(KPC-2) gene,CRE Escherichia coli mainly carried Bla_(NDM-5) gene.Conclusion:CRE has the characteristics of high drug resistance,and it is widely distributed in clinic and comes from a wide range.At the same time,CRE is mainly Klebsiella pneumoniae carrying Bla_(kpc-2) gene and escherichia coli carrying Bla_(NDM-5) gene.