摘要
目的分析耐碳青霉烯类革兰阴性菌(CRO)对头孢他啶/阿维巴坦(CAZ/AVI)的耐药特点及产酶表型,为临床合理用药及感染防控提供指导。方法收集2020年1月至2021年9月临床分离的CRO 206株,采用酶抑制剂增强试验和酶免疫层析法检测碳青霉烯酶分型,纸片扩散法(K-B法)检测CAZ/AVI敏感性,并用E-test法对抑菌圈直径为20~22mm的菌株进行复核。结果206株CRO菌株经鉴定为耐碳青霉烯类肠杆菌131株和铜绿假单胞菌75株,主要来源于神经内科、急诊EICU、神经外科等临床科室。经耐药表型检出,CRO菌株以产A类丝氨酸酶为主。对CAZ/AVI总的耐药率为17.5%(36/206),产丝氨酸酶菌株对CAZ/AVI的耐药率为5.7%(6/106),产金属酶菌株对CAZ/AVI 100%(21/21)耐药。其中肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、阴沟肠杆菌对CAZ/AVI的耐药率分别为8.7%(9/104)、13.3%(10/75)、91.7%(11/12)、100%(6/6),产气克雷伯菌、奇异变形杆菌、产酸克雷伯菌对CAZ/AVI均100%敏感。有30株CAZ/AVI抑菌圈直径为20~22mm的菌株经E-test法复核,一致率为96.7%(29/30)。36株耐CAZ/AVI的CRO菌株耐药基因结果显示,产KPC 6株,产NDM 21株、产VIM 1株、产IMP 2株,KPC+NDM混合基因型1株。结论碳青霉烯酶肠杆菌耐药主要与产丝氨酸酶相关,但产碳青霉烯酶并不是铜绿假单胞菌对其耐药的主要机制。产非金属碳青霉烯酶CRO对CAZ/AVI有很好的抑菌活性,因此碳青霉烯酶分型检测对于临床合理使用CAZ/AVI具有指导意义。
Objective To analyze the resistance characteristics and enzyme producing phenotype of Carbapenem resistant gram-negative bacteria(CRO)to Ceftazidime/avibactam(CAZ/AVI),so as to provide a guidance for clinical rational drug use and infection prevention.Methods 206 strains of CRO clinically isolated from January,2020 to September,2021 were collected for the study,and carbapenem enzyme typing was detected by enzyme inhibitor enhancement test and enzyme immunochromatography.CAZ/AVI sensitivity was detected by disk diffusion method(K-B method),and strains with inhibition zone diameter of 20-22mm were reviewed by E-test method.Results 206 CRO strains were identified as 131 carbapenem-resistant enterobacter and 75 pseudomonas aeruginosa,mainly from Neurology,Emergency EICU,Neurosurgery and other clinical departments.The resistant phenotype showed that CRO strains mainly produced serinase A.The total resistance rate to CAZ/AVI was 17.5%(36/206).The drug resistance rate of serinase-producing strains to CAZ/AVI was 5.7%(6/106),and that of metalase producing strains to CAZ/AVI was 100%(21/21).The drug resistance rates of Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli and Enterobacter cloacae to CAZ/AVI were 8.7%(9/104),13.3%(10/75),91.7%(11/12)and 100%(6/6),respectively.Klebsiella aerogenes,Proteus mirabilis and Klebsiella oxytoca were 100%sensitive to CAZ/AVI.Thirty strains of CAZ/AVI with a diameter of 20-22mm were checked by E-test,and the agreement rate was 96.7%(29/30).The results of drug resistance genes of 36 CAZ/AVI resistant CRO strains showed that 6 strains produced KPC,21 strains produced NDM,1 strain produced VIM,2 strains produced IMP,and 1 strain produced KPC+NDM mixed genotype.Conclusion The resistance of Enterobacter Carbapenem is mainly related to the production of serine enzyme,but the production of Carbapenem enzyme is not the main mechanism of resistance of Pseudomonas aeruginosa to it.Non-metallic carbapenemase CRO has a good antibacterial activity on CAZ/AVI.Therefore,Carbapenase typing is of guiding significance for the rational use of CAZ/AVI in clinical practice.
作者
韩静
寿好长
段学光
张省委
李泉旺
HAN Jing;SHOU Haochang;DUAN Xueguang;ZHANG Shengwei;LI Quanwang(Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China)
出处
《标记免疫分析与临床》
CAS
2023年第11期1825-1830,共6页
Labeled Immunoassays and Clinical Medicine
基金
北京中医药大学基本科研青年教师项目(编号:2019-JYB-JS-152)
北京市丰台区卫生健康系统立项科研项目(编号:2020-80)。
