重庆某院耐万古霉素屎肠球菌的分子流行病学研究和感染危险因素分析

发布时间：2018-01-17 19:00

本文关键词：重庆某院耐万古霉素屎肠球菌的分子流行病学研究和感染危险因素分析　出处：《第三军医大学学报》2016年03期 　论文类型：期刊论文

【摘要】：目的探究耐万古霉素屎肠球菌(vancomycin-resistant Enterococcus faecium,VREfm)的毒力基因、转座子分型和危险因素。方法收集本院2012年1月至2014年2月经微量肉汤稀释法验证的耐万古霉素屎肠球菌18株,采用梅里埃VITEK2对13种抗生素进行MIC检测;通过多重PCR检测Van耐药基因和7种毒力基因,重叠PCR分析耐药转座子Tn1546结构,多位点序列分型(multilocus sequence typing,MLST)方法确定菌株序列型别,并采用回顾性病例对照分析进行危险因素调查。结果 18株VREfm基因型和表型均符合Van A型;所有菌株对青霉素、氨苄西林、环丙沙星等表现耐药,对替加环素、利奈唑胺和奎奴普丁-达福普汀表现敏感;毒力基因acm、esp、hyl检测率分别为94.4%、88.9%、83.3%;耐药转座子结构共检测到4种类型;MLST结果显示共有5种ST型别,均属于克隆复合体CC17。毒力基因esp、转院患者、尿路感染和万古霉素使用是VREfm感染的独立危险因素。结论收集到的18株VREfm均为多重耐药菌,且均属于克隆复合体CC17。毒力基因esp检出率较高,且与万古霉素耐药显著相关。
[Abstract]:Objective to investigate the virulence gene of vancomycin-resistant Enterococcus faecium (VREfm) resistant to vancomycin-resistant Enterococcus faecium. Methods from January 2012 to 2014, 18 strains of vancomycin resistant Enterococcus faecium were collected. Meridier VITEK2 was used to detect 13 antibiotics by MIC. Multiplex PCR was used to detect Van resistance gene and 7 virulence genes. Overlapping PCR was used to analyze the Tn1546 structure of drug resistance transposon. Multilocus sequence typing method was used to determine the sequence type of the strain. A retrospective case-control analysis was used to investigate the risk factors. Results the genotypes and phenotypes of 18 VREfm strains were all consistent with Van A genotype. All strains showed resistance to penicillin, ampicillin, ciprofloxacin, and were sensitive to tegacycline, linazolamine and quinuputene. The detection rate of virulence gene acmelphyl was 94. 4% and 88. 9% and 83. 3%, respectively. Four types of drug-resistant transposon structures were detected. MLST results showed that there were 5 ST-types, all of which belonged to CC17.The virulence gene ESP was transferred to hospital. Urinary tract infection and vancomycin use are independent risk factors for VREfm infection. Conclusion all 18 strains of VREfm collected are multidrug resistant bacteria. The virulence gene esp was highly detectable and was significantly correlated with vancomycin resistance.
【作者单位】：重庆医科大学附属第一医院检验科;
【基金】：国家自然科学基金面上项目(81471992)~~
【分类号】：R446.5
【正文快照】： 肠球菌已逐渐成为院内感染的重要病原菌,尤以粪肠球菌和屎肠球菌多见。据2013年中国CHINET细菌耐药监测报道,肠球菌属细菌分离率高居阳性球菌第2位,其中屎肠球菌约占43.4%,且对所测试药物的耐药率均较高[1]。随着我国糖肽类抗生素的广泛使用,万古霉素耐药肠球菌感染逐年增多。

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