摘要
目的探讨对碳青霉烯类抗菌药物敏感性降低的肠杆菌科细菌携带碳青霉烯酶基因的类型。方法收集2016年2月至2017年2月武汉大学人民医院分离自临床的87株对碳青霉烯类抗菌药物敏感性降低的肠杆菌科细菌。运用改良Hodge试验进行碳青霉烯酶的表型确证。PCR检测碳青霉烯酶基因:blaKPC、blaNDM、blaIMP、blaVIM。将PCR产物纯化后进行测序,运用SeqMan软件对测序结果进行拼接后在NCBI网站BLAST比对,得到碳青霉烯酶基因亚型。结果 87株碳青霉烯类抗菌药物不敏感肠杆菌科细菌中,产碳青霉烯酶菌株检出率为70.1%,携带blaKPC-2、blaNDM-1、blaNDM-5、blaIMP-4和blaVIM-1的菌株分别为29、16、11、7和1株。产碳青霉烯酶最多的肠杆菌科细菌为肺炎克雷伯菌(33株),其次为大肠埃希菌(15株),肺炎克雷伯菌以产KPC型碳青霉烯酶为主,而大肠埃希菌仅产NDM型碳青霉烯酶。改良Hodge试验检测碳青霉烯酶的灵敏度、特异度、阳性预测值和阴性预测值分别为93.4%、96.2%、98.3%和86.2%,可准确检测KPC-2和NDM-5型碳青霉烯酶。碳青霉烯类抗菌药物不敏感肠杆菌科细菌对碳青霉烯类抗菌药物亚胺培南和美罗培南的不敏感率分别为93.1%和79.3%,产KPC和NDM肠杆菌科细菌对青霉素类、除第四代头孢菌素以外的头孢菌素类、碳青霉烯类及加酶抑制剂的复合制剂耐药率均为100%,对其他临床常用抗菌药物的耐药率均保持在较高水平。结论本院碳青霉烯类抗菌药物不敏感肠杆菌科细菌株主要产KPC-2、NDM-1和NDM-5型碳青霉烯酶。
Objective To investigate the type of carbapenem gene carried by Enterobacteriaceae bacteria with low susceptibility to carbapenems. Methods Total of 87 carbapenem-nonsusceptible Enterobacteriaceae strains isolated from clinical samples in Renmin Hospital of Wuhan University from February 2016 and February 2017 were collected. The phenotypes of carbapenemases were identified by Modified Hodge Test. The carbapenemase genes（blaKPC, blaNDM, blaIMP and blaVIM） were detected by PCR. And the nucleotide sequences were compared with the sequences available by BLAST comparison on NCBI. Results The detection rate of carbapenemase-producing strains was 70.1% among 87 carbapenemnonsusceptible Enterobacteriaceae strains. The strains carrying blaKPC-2, blaNDM-1, blaNDM-5, blaIMP-4 and blaVIM-1 were 29 strains, 16 strains, 11 strains, 7 strains and 1 strain, respectively. The most common carbapenemase-producing strains were Klebsiella pneumoniae（33 strains） and followed by Escherichia coli（15 strains）. Klebsiella pneumoniae mainly produced KPC-carbapenemase and Escherichia coli only produced NDM-carbapenemase. The sensitivity, specificity, positive predictive value and negative predictive value of Modified Hodge Test for carbapenemase were 93.4%, 96.2%, 98.3% and 86.2%, respectively. And the insensitivity rates of carbapenem-nonsusceptible Enterobacteriaceae strains to imipenem and meropenem were 93.1% and 79.3%, respectively. The resistance rates of KPC and NDM-producing Enterobacteriaceaestrains to penicillins, cephalosporins, carbapenems and compound preparation with enzyme inhibitors were all 100%. Conclusions The carbapenem-nonsusceptible Enterobacteriaceae strains isolated from our Hospital mainly produced KPC-2, NDM-1 and NDM-5 carbapenemases.
作者
冯丽娜
李从荣
杨勇文
姜树朋
蔡璇
李娟
冯锴
郭静
Feng Lina;Li Congrong;Yang Yongwen;Jiang Shupeng;Cai Xuan;Li Juan;Feng Kai;Guo Jing(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2018年第4期334-340,共7页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
国家临床重点专科建设项目(No.财社[2010]305)
