碳青霉烯类耐药的肠杆菌科细菌耐药基因检测及临床特征分析

发布时间：2018-07-15 14:37

【摘要】：目的:通过对碳青霉烯类耐药的肠杆菌科细菌耐药基因的检测及临床特征分析,一方面了解其耐药机制,另一方面了解我院患者感染碳青霉烯类耐药的肠杆菌科细菌的危险因素,从而为抗菌药物的合理应用及对感染的防控提供科学依据。方法:收集本院临床分离的多重耐药肠杆菌科细菌,使用VITEK-2 compact、VITEK-MS全自动微生物分析仪鉴定菌种和药物敏感性试验。采用聚合酶链反应(PCR)对其相关耐药基因进行检测。并分析本研究中菌株的相关临床特征。结果:65株耐碳青霉烯类肠杆菌科细菌除对亚胺培南、阿米卡星、多粘菌素B耐药率较低外,对其余药物耐药率均在50%以上;其对厄他培南、美罗培南、亚胺培南的耐药率分别为100%、75%、8%;耐药率均为100%的药物有头孢西丁、头孢曲松、头孢他啶以及头孢哌酮/舒巴坦。基因型检测为阳性的基因共7种,其阳性率分别为IMP(18.5%)、KPC(25%)、TEM(33%)、CTX(100%)、SHV(25%)、OXA-1(1.5%)、OXA-2(10.8%);其中有关67%的菌株携带2种以上耐药基因,并有4株菌株携带四种耐药基因。通过对相关临床特征的分析,其中住院天数、侵入性操作和院内感染是CRE感染的独立危险因素(P0.05)。结论:肠杆菌科细菌的耐药与其产生多种耐药基因密不可分,其中常见的是碳青霉烯类相关基因和ESBLs相关基因,因此可能是导致本地区肠杆菌科细菌对碳青霉烯类药物耐药率高的重要原因。相关部门也应当做好感控措施,适当减少患者的住院周期,同时降低侵入性操作的频率,并且合理的使用抗菌药物。
[Abstract]:Objective: to investigate the mechanism of carbapenem resistance in Enterobacteriaceae by detecting its resistance gene and analyzing its clinical characteristics. On the other hand, the risk factors of infection of carbapenem resistant Enterobacteriaceae in patients in our hospital were studied, so as to provide scientific basis for rational use of antimicrobial agents and prevention and control of infection. Methods: the multidrug resistant Enterobacteriaceae bacteria were collected and identified by VITEK-2 Compactact VITEK-MS automatic microbiological analyzer. Polymerase chain reaction (PCR) was used to detect the related drug resistance genes. The clinical characteristics of the strains in this study were analyzed. Results among 65 strains of Enterobacteriaceae, the rates of resistance to imipenem, amikacin and polymyxin B were all over 50%, and to ertapenem and meropenem. The resistance rates of imipenem were 100% and 100%, respectively, and cefoperazone, ceftriaxone, ceftazidime and cefoperazone / sulbactam were 100%. There were 7 genotypic positive genes, the positive rates of which were IMP (18.5%), KPC (25%), Tem (33%), CTX (100%), SHV (25%), OXA-1 (1.5%), OXA-2 (10.8%). Through the analysis of related clinical characteristics, the days of hospitalization, invasive operation and nosocomial infection were independent risk factors of CRE infection (P0.05). Conclusion: the drug resistance of Enterobacteriaceae is closely related to the production of multidrug resistance genes, among which carbapenem related genes and ESBLs-associated genes are common. Therefore, it may be an important reason for the high resistance rate of Enterobacteriaceae to carbapenem in this area. The departments concerned should also take favorable measures to reduce the hospitalization period of patients, reduce the frequency of invasive operation, and use antibiotics rationally.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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