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耐碳青霉烯类肠杆菌目细菌耐药性及耐药基因分型

A Study of Drug Resistance and Resistance Genotyping ofCarbapenem- resistant Enterobacterales
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摘要 目的 分析临床分离的耐碳青霉烯类肠杆菌目细菌(CRE)类型、来源、临床分布、耐药性、耐药基因分型,为临床合理使用抗菌药物提供实验室依据。方法 收集深圳市南山区两家三级医院2020年7月至2021年6月临床分离的CRE菌株34株。应用VITEK MS全自动快速微生物质谱检测系统和VITEK-2 Compact全自动微生物鉴定药敏系统进行细菌鉴定与药敏试验,采用碳青霉烯酶抑制剂增强试验(PBA-EDTA法)检测碳青霉烯酶耐药表型,采用聚合酶链反应(PCR)方法检测碳青霉烯酶耐药基因。结果 分离的34株CRE菌株包括肺炎克雷伯菌24株,大肠埃希菌8株,弗劳地枸橼酸杆菌1株,产气肠杆菌1株。标本主要来自呼吸道、泌尿道、血液等。CRE菌株对各类抗菌药物表现出不同程度的耐药率,对头孢曲松、美罗培南、厄他培南、氨苄西林/舒巴坦、头孢哌酮/舒巴坦的耐药率为100%,对环丙沙星、左氧氟沙星、头孢他啶、头孢吡肟、氨曲南、亚胺培南、哌拉西林/他唑巴坦的耐药率为94%以上。PBA-EDTA法与PCR法对碳青霉烯酶的检出率差异无统计学意义。结论 CRE菌株主要为肺炎克雷伯菌,耐药基因主要为blaKPC。采用碳青霉烯酶抑制剂增强试验(PBA-EDTA法)进行碳青霉烯酶检测,比较适合临床微生物实验室常规开展,对于临床合理使用抗菌药物和院感防控具有重要作用。 Objective To analyze the species,source,clinical distribution,drug resistance,drug resistance genotypes of clinical isolates of carbapenem-resistant Enterobacterales(CRE),so as to provide knowledge basis for reasonable use of antibiotics in clinic laboratory.Methods A total of 34 clinical isolates of CRE were collected from two tertiary hospitals in Nanshan District,Shenzhen from July,2020 to June,2021.The clinical isolates were identified by using VITEK MS automatic microorganism analysis system,and the drug sensitivity test was performed by VITEK-2 compact automatic microorganism analysis system.Drug resistance phenotypes of carbapenemases were detected by using carbapenemase inhibitor enhancement test(PBA-EDTA assay),and carbapenemases resistance genes were detected by using polymerase chain reaction(PCR).Results Among 34 clinical CRE isolates,there were 24 strains of Klebsiella pneumoniae,8 strains of Escherichia coli,1 strain of Citrobacter freundii,and 1 strain of Enterobacter aerogenes.Most of the strains were isolated from respiratory tract,urinary tract,and blood.CRE strains showed different degrees of resistance to various antibiotics.The drug resistance rates to cefatriaxone,meropenem,ertapenem,ampicillin/sulbactam,and cefoperazone/sulbactam were 100%.The drug resistance rates to ciprofloxacin,levofloxacin,ceftazidime,cefepime,aztreonam,imipenem,piperacillin/tazobactam were more than 94%.There was no significant difference in the detection rate of carbapenemase between PBA-EDTA method and PCR method.Conclusion In this study,CRE strains were mainly Klebsiella pneumoniae and the drug resistance genes were mainly bla KPC.Carbapenemase inhibitor enhancement test for detection of carbapenemase(PBA-EDTA method)is suitable for the routine development of clinical microbiology laboratory,and can play an important role in the rational clinical use of antimicrobial drugs and the prevention of hospital infection.
作者 辛续丽 魏勇 张佳纯 陈莉 贺松 XIN Xuli;WEI Yong;ZHANG Jiachun;CHEN Li;HE Song(Clinical Laboratory,Shenzhen Qianhai Shekou Free Trade Zone Hospital,Shenzhen 518067,China)
出处 《标记免疫分析与临床》 CAS 2023年第10期1695-1699,1800,共6页 Labeled Immunoassays and Clinical Medicine
基金 南山区卫生科技项目(编号:深南科[2020]2020077)。
关键词 肠杆菌目细菌 碳青霉烯酶 耐药性 耐药基因 碳青霉烯酶抑制剂增强试验 Enterobacterales Carbapenemase Drug resistance Drug resistance gene Carbapenemase inhibition enhancement test
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