耐碳青霉烯类肠杆菌198株临床分离株耐药性及其耐药基因

Resistance of 198 carbapenem-resistant Enterobacteriaceae clinical isolates and their resistance genes

目的分析耐碳青霉烯类肠杆菌(CRE)耐药现状并检测其相关耐药基因,为临床治疗CRE感染,合理使用抗菌药物提供参考。方法收集复旦大学附属中山医院2020年1月-2021年12月患者临床标本分离的耐碳青霉烯类肠杆菌非重复分离株共198株,使用肉汤微量稀释法检测分离株对临床常用的抗菌药物的最低抑菌浓度,并通过聚合酶链反应对CRE的碳青霉烯酶进行相关耐药基因的检测。结果198株CRE菌株中,165株产blaKPC占83.33%,20株产blaNDM占10.10%,3株产blaIMP占1.52%,还有2株同时产blaKPC+NDM占1.01%。本研究中产丝氨酸酶的CRE菌株对头孢他啶/阿维巴坦(CZA)敏感率为100.00%,产金属酶的CRE菌株对CZA敏感率为0,此外CRE对黏菌素和替加环素的敏感率均>90%。结论和其他临床常用抗菌药物相比,黏菌素和替加环素对产碳青霉烯酶的肠杆菌目细菌具有较好的体外抗菌活性,此外头孢他啶/阿维巴坦对产丝氨酸酶的CRE菌株也具有较好的抗菌活性。

OBJECTIVE To analyze the current status of antibacterial activity of carbapenem resistant Enterobacteriaceae(CRE)and detect their related resistance genes,so as to provide reference for clinical treatment of CRE infection and rational use of antibiotics.METHODS A total of 198 non-repetitive isolates of carbapenem resistant Enterobacteriaceae isolated from clinical specimens of patients at Zhongshan Hospital affiliated to Fudan University from Jan.2020 to Dec.2021 were collected,and the lowest inhibitory concentrations of the isolates against antimicrobial drugs commonly used in clinical practice were detected using the broth microdilution method,and the carbapenemase-related resistant genes of CRE were detected by polymerase chain reaction.RESULTS Among 198 CRE strains,165 strains produced blaKPC(83.33%),20 strains produced blaNDM(10.10%),3 strains produced blaIMP(1.52%),and 2 strains simultaneously produced blaKPC+NDM(1.01%).In this study,the sensitivity of serine carbapenemases-producing CRE strain to CZA was 100.00%,and that of metallo-beta-lactamase-producing CRE strains to CZA was 0.In addition,the sensitivity of CRE to colistin and tigecycline was 90%.CONCLUSION Compared with other commonly used clinical antibiotics,colistin and tegacyclin showed better in vitro activity against CRE,and ceftazidime/avibactam also showed better antibacterial activity against serine-producing CRE strains.