摘要
目的检测部分发酵类肠杆菌科细菌对临床推荐用抗生素的敏感性并筛查耐碳青霉烯类基因。方法采集鄂西北地区2013年1-12月间住院病人的血、痰、中段尿、前列腺液、分泌物或引流液等,常规琼脂培养法分离发酵类肠杆菌肺炎克雷伯菌(Klebsiella pneumoniae)、产酸克雷伯菌(Klebsiella oxytoca)、大肠埃希菌(Escherichia coli)、阴沟肠杆菌(Enterbacter cloacae)及沙雷氏菌(Serratia);利用Vitek-2分析系统鉴定菌株并检测其耐药性;PCR法扩增抗碳青霉烯类(亚胺培南和/或美罗培南)菌株耐药基因。结果共获得2 291株肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌和沙雷氏菌等分离株,产ESBLs率分别为47.4%、62.6%、9.1%、22.6%;临床推荐用抗生素耐药率:头孢唑啉(Ⅰ)分别为45.4%、73.7%、93.3%、100%,头孢西丁(Ⅱ)分别为17.3%、15.2%、84.9%、33.3%,头孢曲松(Ⅲ)分别为48.4%、65.0%、43.8%、44.4%;阿米卡星分别为17.4%、10.4%、28.1%、24.4%,氨曲南分别为35.4%、38.9%、49.1%、38.9%,亚胺培南(分别为1.8%、1.8%、17.6%、2.4%,美罗培南分别为1.1%、0.8%、6.7%、20%。其中分离出46株耐亚胺培南和/或美罗培南菌株,肺炎克雷伯菌P2964和肺炎克雷伯菌B195携带blaKPC-2基因,肺炎克雷伯菌P6558和产酸克雷伯菌B1645-1携带blaNDM-1基因。结论鄂西北地区部分发酵类肠杆菌耐药率呈上升趋势并出现耐碳青霉稀类菌株,菌株间可能存在耐药基因的传递并有造成感染扩散的风险,尤其在住院病人之间,应予以高度重视。
Objective To detect the drug susceptibility of Enterobacteriaceaestrains and to screen for genes conferring resistance to carbapenems. Methods Samples of blood,sputum,midstream urine,prostatic fluid,secretions,and drainage fluid were collected from inpatients January 2013 to December 2013 in northwest Hubei.Based on a conventional agar culture and results of analysis with the Vitek-2system,lactose-fermenting Enterobacteriaceae such as Klebsiella pneumoniae,K.oxytoca,Escherichia coli,Enterobacter cloacae,and Serratia were isolated and their drug resistance was detected.A universal primer was designed based on the carbapenemase-encoding genes blaKPC-2,blaNDM-1,blaSHV,blaIMP,and blaVIM.Genes of strains that were resistant to carbapenems（imipenem and/or meropenem）were amplified with PCR. Results A total of 2 291 isolates of K.pneumoniae,E.coli,E.cloacae,and Serratia were obtained in this study.Of the K.pneumoniae isolates,47.4% were ESBL-producing bacteria.Of the E.coli isolates,62.6% were ESBL-producing bacteria.Of the E.cloacaeisolates,9.1% were ESBL-producing bacteria.Of the Serratia isolates,22.6% were ESBL-producing bacteria.The resistance of isolates to recommended antibiotics was studied.Resistance of K.pneumoniae to cefazolin（I）was 45.4%,resistance of E.coli to cefazolin（I）was 73.7%,resistance of E.cloacae to cefazolin（I）was 93.3%,and resistance of Serratiato cefazolin（I）was 100%.Resistance of K.pneumoniae to cefoxitin（II）was 17.3%,resistance of E.coli to cefoxitin（II）was 15.4%,resistance of E.cloacaeto cefoxitin（II）was 84.9%,and resistance of Serratiato cefoxitin（II）was 33.3%.Resistance of K.pneumoniaeto ceftriaxone（III）was 48.4%,resistance of E.coli to ceftriaxone（III）was 65%,resistance of E.cloacae to ceftriaxone（III）was 43.8%,and resistance of Serratia to ceftriaxone（III）was 44.4%.Resistance of K.pneumoniae to amikacin was17.4%,resistance of E.coli to amikacin was 10.4%,resistance of E.cloacaeto amikacin was 28.1%,and resistance of Serratiato amikacin was 24.4%.Resistance of K.pneumoniaeto aztreonam was 35.4%resistance of E.coli to aztreonam was 38.9%,resistance of E.cloacaeto aztreonam was 49.1%,and resistance of Serratiato aztreonam was 38.9%.Resistance of K.pneumoniaeto imipenem was 1.8%,resistance of E.coli to imipenem was 1.8%,resistance of E.cloacae to imipenem was 17.6%,and resistance of Serratiato imipenem was 2.4%.Resistance of K.pneumoniaeto meropenem was 1.1%,resistance of E.coli to meropenem was 0.8%,resistance of E.cloacaeto meropenem was 6.7%,and resistance of Serratiato meropenem was 20%.Of the isolates,46were carbapenem-resistant strains.K.pneumoniae P2964and K.pneumoniae B195carried the blaKPC-2gene and K.pneumoniae P6558and K.oxytoca B1645-1carried the blaNDM-1gene.Conclusion The drug resistance of some Enterobacteriaceae strains in the northwest portion of Hubei Province is increasing and some strains are carbapenem-resistant.There may be a risk of drug resistance genes being transmitted between strains,and attention must be paid to the risk of a spread of infection,especially among inpatients.
作者
王祖华
田雨桐
景瑞婷
余春芳
金志雄
WANG Zu-hua TIAN Yu-tong JING Rui-ting YU Chun-fang JIN Zhi-xiong(Department of Basic Medical Science, Hubei University of Medicine, Shiyan, Hubei 442000, Chin)
出处
《中国病原生物学杂志》
CSCD
北大核心
2017年第9期818-824,共7页
Journal of Pathogen Biology
基金
湖北省教育厅项目(No.B2013118)
湖北医药学院创新团队项目(No.FDFR201602)
关键词
肠杆菌科细菌
碳青霉烯类
NDM-1
耐药性
Enterobacteriaceae
carbapenem
New Delhi metallo-beta-lactamase 1（NDM-1）
resistance
