碳青霉烯类耐药粘质沙雷菌β-内酰胺类耐药基因的调查研究

发布时间：2018-04-02 03:07

本文选题：粘质沙雷菌　切入点：耐药基因　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的对临床分离的碳青霉烯类耐药粘质沙雷菌β-内酰胺类耐药基因携带情况进行调查研究,探讨其耐药机制。方法收集2013-2015年安徽医科大学第一附属医院155株和安徽医科大学第二附属医院87株,共计242株临床分离的粘质沙雷菌,采用Vitek-2 Compact全自动微生物系统对其鉴定并进行药敏试验,从中筛选出对亚胺培南耐药18株、中介1株;再用K-B法检测19株细菌对厄他培南和美罗培南的药物敏感性,确认均为耐药;采用改良Hodge试验及EDTA协同试验检测碳青霉烯酶;PCR检测碳青霉烯酶基因bla KPC、bla NMC、bla IMP、bla GIM、bla VIM、bla OXA-23及超广谱β-内酰胺酶基因bla VEB、bla PER、bla TEM、bla SHV、bla CTX-M-1、bla CTX-M-2、bla CTX-M-9,阳性结果进行DNA测序,BLAST比对确定其基因型。结果药敏实验结果显示,19株细菌对美罗培南、厄他培南、氨曲南、环丙沙星、头孢唑林、头孢曲松、头孢噻肟全部耐药,对亚胺培南18株耐药、1株中介;对阿米卡星全部敏感;对庆大霉素敏感率为57.9%;妥布霉素敏感率为26.3%;对头孢替坦、头孢他啶均为15.8%;对头孢吡肟敏感率为10.5%;左氧氟沙星、哌拉西林/他唑巴坦敏感率均为5.3%;19株细菌改良Hodg试验阳性18株,阴性1株;EDTA协同试验全部阴性;PCR扩增和DNA测序显示,7株含bla KPC-2基因、6株含bla CTX-M-14基因、3株含bla SHV-11基因、2株含bla SHV-12基因、1株含bla OXA-23基因;19株细菌均未检出bla NMC、bla IMP、bla GIM、bla VIM碳青霉烯酶基因及bla VEB、bla PER、bla TEM、bla CTX-M-1、bla CTX-M-2超广谱β-内酰胺酶基因。结论安徽医科大学第一、第二附属医院临床分离的碳青霉烯类耐药粘质沙雷菌,耐药现象较为严重,主要携带KPC-2型基因和CTX-M-14型基因,携带率分别为31.6%和36.8%。
[Abstract]:Objective to investigate the carrying status of 尾 -lactam resistance genes in clinical isolates of carbapenem resistant Shareh strain. Methods from 2013 to 2015, 155 strains from the first affiliated Hospital of Anhui Medical University and 87 strains from the second affiliated Hospital of Anhui Medical University were collected. 18 strains of imipenem resistance and 1 strain mediated by imipenem were screened by Vitek-2 Compact automatic microbiological system, and 19 strains of bacteria were tested by K-B method for drug sensitivity to ertapenem and meropenem. All of them were confirmed to be drug-resistant. The modified Hodge test and EDTA synergistic test were used to detect the bla KPCbla nmmmbla GIMPU bla OXA-23 and extended-spectrum 尾 -lactamase gene bla VEBUBUBLA PERBLABLA TEMbla CTX-M-1bla CTX-2bla CTX-2bla CTX-M-9. The results of DNA sequencing were used to determine the blast ratio. Results the results of drug sensitivity test showed that 19 strains of bacteria were resistant to meropenem. Ertapenem, aztreonam, ciprofloxacin, cefazolin, ceftriaxone, cefotaxime were all resistant, and one of them was resistant to imipenem. The sensitivity rate to gentamicin was 57.9; tobramycin was 26.3; ceftazidime was 15.8 for ceftitan; cefepime was 10.5; levofloxacin, piperacillin / tazobactam were all 5. 3and 18 were positive for improved Hodg test of 19 strains of bacteria. DNA sequencing showed that 7 strains with bla KPC-2 gene, 6 strains with bla CTX-M-14 gene, 3 strains with bla SHV-11 gene, 2 strains with bla SHV-12 gene, 1 strain with bla OXA-23 gene and 19 strains of bacteria, were not detected. The gene of carbapenem and bla VEBPERBORA PERBERBLA TEMERBLABA-TEMX-BILA CTX-1BLA CTX-M-2 extended spectrum 尾 -lactamase gene. Conclusion Anhui Medical University is the first. The drug resistance of carbapenem resistant myxobacterium Shareh isolated from the second affiliated hospital was more serious, mainly carrying KPC-2 type gene and CTX-M-14 type gene, the carrying rates were 31.6% and 36.8%, respectively.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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