摘要
目的研究利奈唑胺耐药粪肠球菌(linezolid-resistant Enterococcus faecalis,LRE)的耐药机制并分析其感染的临床特征及危险因素。方法收集2014-2018年从住院患者无菌体液标本中分离的LRE(MIC≥8 mg/L),利用PCR及测序技术检测菌株中的optrA、cfr、poxtA基因,23S rRNA V区突变以及由rplC和rplD编码的核糖体蛋白L3、L4的突变。回顾性收集LRE感染患者的临床和实验室资料,通过病例对照研究对LRE感染的危险因素进行分析。结果5年内共检出85株LRE,耐药机制主要包括获得optrA基因(98.8%),核糖体蛋白L4突变(36.5%)、L3突变(4.7%)。共纳入85例LRE感染病例组和85例利奈唑胺敏感粪肠球菌(linezolid-susceptible Enterococcus faecalis,LSE)感染对照组。多因素分析表明,从外院转入(OR:2.8,95%CI:1.3~6.1,P=0.007)、高龄(≥60岁)(OR:2.3,95%CI:1.1~5.0,P=0.034)、恶性肿瘤(OR:5.5,95%CI:2.5~12.5,P<0.001)、气管插管(OR:3.8,95%CI:1.7~8.3,P=0.001)、先前碳青霉烯类(OR:0.1,95%CI:0~0.5,P=0.003)和氟喹诺酮类(OR:4.3,95%CI:1.4~13.7,P=0.013)的使用为LRE感染的危险因素。结论携带optrA基因是LRE的主要耐药机制,外院转入、高龄、恶性肿瘤、气管插管、先前碳青霉烯类和氟喹诺酮类抗菌药物的使用是LRE感染的独立危险因素。
Objective To investigate the resistance mechanism of linezolid-resistant Enterococcus faecalis(LRE)and analyze clinical features and risk factors of LRE infection.Methods The LRE strains(MIC≥8 mg/L)isolated from aseptic body fluid of inpatients were collected during the period from 2014 to 2018.PCR and sequencing technology were used to identify the resistance mechanisms,including optrA,cfr,and poxtA genes,as well as the mutations of 23S rRNA V region and ribosomal proteins L3 and L4.The clinical and laboratory data were retrospectively collected from the patients with LRE infection.The risk factors for LRE infection were analyzed by case-control study.Results A total of 85 LRE strains were detected in 5 years.Acquisition of optrA(98.8%)was the main mechanism underlying linezolid resistance,followed by L4 protein mutations(36.5%)and L3 protein mutation(4.7%).A case-control study was then conducted with 85 LRE cases and 85 linezolid-susceptible Enterococcus faecalis(LSE)controls.Multivariate analysis showed that the transfer from another hospital(OR,2.8;95% CI,1.3-6.1;P=0.007),elderly(≥60 years)(OR,2.3;95%CI,1.1-5.0;P=0.034),malignant tumor(OR,5.5;95% CI,2.5-12.5;P<0.001),endotracheal intubation(OR,3.8;95%CI,1.7-8.3;P=0.001),prior carbapenem therapy(OR,0.1;95% CI,0-0.5;P=0.003),and prior fluoroquinolones use(OR,4.3;95%CI,1.4-13.7;P=0.013)were risk factors for LRE infection.Conclusions It seems that optrA is the primary mechanism for linezolid resistance in Enterococcus faecalis.Transfer from another hospital,elderly,malignant tumor,endotracheal intubation,prior carbapenem therapy,and prior fluoroquinolones use are independent risk factors for LRE infection.
作者
邹家齐
夏云
ZOU Jiaqi;XIA Yun(Department of Laboratory Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2020年第2期169-174,共6页
Chinese Journal of Infection and Chemotherapy
基金
国家自然科学基金面上项目(81572055)。