碳青霉烯耐药肠杆菌科细菌基因型检测技术研究进展

Progress of research on genotyping technology for carbapenem-resistant Enterobacteriaceae

革兰阴性肠杆菌科细菌是一类重要的临床致病菌,碳青霉烯类药物被称为治疗革兰阴性菌的“最后一道防线”。随着碳青霉烯类药物的广泛使用,碳青霉烯类耐药肠杆菌科细菌(CRE)的检出率逐年攀升,给临床抗感染治疗带来严峻挑战。产碳青霉烯酶是CRE的主要耐药机制,不同的碳青霉烯酶对药物的水解能力不同,增加了对CRE治疗的复杂性。因此,准确、快速地检测耐药菌株及鉴定耐药基因型,对于防控耐药菌株的传播、指导临床精准用药具有重要的价值。本文主要对CRE的耐药机制以及临床或检验实验室使用的基因型检测方法进行了综述,为未来CRE检测技术的发展及其防控提供参考依据。

Gram-negative Enterobacteriaceae is a major genus of clinically isolated pathogens, and carbapenems are known as the ′last line of defense′ for the treatment of gram-negative bacteria. With the widespread use of carbapenems, the detection rate of carbapenem-resistant Enterobacteriaceae(CRE) was increased year by year, bringing severe challenges to clinical treatment of infection. The production of carbapenemase is the leading drug resistance mechanism, and the carbapenemases vary in hydrolysis capabilities of drugs, which makes the treatment of CRE complicated. Therefore, accurate and rapid detection of drug-resistant strains and identification of drug-resistant genotypes are of great value for prevention and control of the spread of drug-resistant strains and reasonable clinical use of drugs. The drug resistance mechanisms of CRE and clinical or laboratory genotyping methods were reviewed in this article, which provides bases for development of CRE detection technology and control of the strains.