我国五省市碳青霉烯药物不敏感肠杆菌耐药机制分析

发布时间：2019-05-22 19:27

【摘要】：目的了解我国五省市六家三甲医院碳青霉烯类抗生素不敏感肠杆菌KPC耐药基因携带和膜蛋白缺失情况。方法收集2012年10月-2014年12月碳青霉烯类抗生素不敏感大肠埃希菌和肺炎克雷伯菌共135株。运用改良Hodge试验进行KPC表型初步筛选,PCR法进行KPC耐药基因和膜蛋白基因检测。多位点序列分析(MLST)和脉冲场凝胶电泳(PFGE)对KPC酶阳性菌株进行同源性分析。结果共有115株菌Hodge试验阳性。65株菌检测到KPC耐药基因,有13株菌所测膜蛋白全部缺失。8株KPC阳性大肠埃希菌ST131型占主导地位;57株KPC阳性肺炎克雷伯菌主导型别是ST11。PFGE结果显示部分菌株同源性较高。结论 KPC酶在碳青霉烯类抗菌药物不敏感的菌株中起主导作用,而膜蛋白的缺失也是导致耐药的一个协同因素。不同地区菌株的主要耐药机制和主导分子型别一致,同时某些医院存在部分分子型别小规模流行,临床工作中应特别注意监控,以防大规模扩散和地区间传播。
[Abstract]:Objective to investigate the KPC resistance gene carrying and membrane protein deletion of enterobacillus insensitive to carbapenem antibiotics in six third class A hospitals in five provinces and cities in China. Methods 135 strains of carbapenem insensitive Escherichia coli and Klebsiella pneumoniae were collected from October 2012 to December 2014. The phenotype of KPC was screened by modified Hodge test, and the drug resistance gene and membrane protein gene of KPC were detected by PCR. Multiple site sequence analysis (MLST) and pulse field gel electrophoresis (PFGE) were used to analyze the homology of KPC enzyme positive strains. Results A total of 115 strains were positive for Hodge test. 65 strains were detected for KPC resistance gene, and 13 strains were deleted from membrane protein. 8 strains of KPC positive Escherichia coli ST131 were dominant. The dominant type of 57 strains of KPC positive Klebsiella pneumoniae was ST11.PFGE. The results showed that some strains had high homology. Conclusion KPC enzyme plays a leading role in strains insensitive to carbapenem antibiotics, and the deletion of membrane protein is also a synergistic factor leading to drug resistance. The main drug resistance mechanism and dominant molecular types of strains in different regions were the same. At the same time, some molecular types were small-scale epidemic in some hospitals. Special attention should be paid to monitoring in clinical work to prevent large-scale spread and interregional transmission.
【作者单位】：烟台芝罘医院;解放军疾病预防控制所;沈阳军区总医院;
【分类号】：R440

【相似文献】