儿童耐万古霉素肠球菌的表型测定与基因分型

发布时间：2018-02-20 20:25

本文关键词： 耐万古霉素肠球菌 PCR 基因分型耐药性　出处：《南昌大学》2006年硕士论文　论文类型：学位论文

【摘要】：研究背景：肠球菌是条件致病菌，可导致人体多脏器的感染，不仅可引起尿路感染、皮肤软组织感染，还可以引起危及生命的腹腔感染、败血症、心内膜炎和脑膜炎等。近年来抗生素的广泛应用使肠球菌对β-内酰胺类和高浓度氨基糖苷类抗生素的耐药性增加，同时也出现耐万古霉素肠球菌，多重耐药的肠球菌的出现给临床治疗造成了极大的困难，因此应广泛引起重视。VRE在美国疾病控制中心(CDC)被列为第二院内感染病原体，主要引起院内感染，暴发流行多发生于重症监护病房和血液肿瘤病房等患有危重疾病和免疫功能低下的患者，所致感染发病率和死亡率高。肠球菌对万古霉素耐药主要有5种基因型：VanA、VanB、VanC、VanD、VanE。临床上的VRE大多属于VanA型耐药，VanA型耐药的VRE对万古霉素呈现高水平耐药(MIC为64～512mg／L)，VanA型耐药可以被万古霉素和替考拉宁诱导产生。该型耐药菌株多见于屎肠球菌和粪肠球菌，多由质粒介导。VanB型耐药株对替考拉宁敏感，，对万古毒素的耐药水平则有很大差异。同时也多见于屎肠球菌和粪肠球菌中。VanC型耐药对万古霉素呈天然低水平耐药，对替考拉宁敏感。耐万古霉素肠球菌的基因分型鉴定对于其流行病学分析和感染控制具有重要意义。近年来，随着分子生物学技术的发展，PCR技术已应用于耐万古霉素肠球的基因分型和相关研究。目的：研究肠球菌临床分离株的耐药性，调查肠球菌对万古霉素的耐药状况，检测耐万古霉素肠球菌的耐药表型和基因型，并为临床治疗用药、控制院内感染及进行流行病学调查提供依据。方法：1．对江西省儿童医院临床标本中分离的165株肠球菌采用微量肉汤稀释法测定9种抗菌药物的最低抑菌浓度(MIC)。2．对分离出来的万古霉素不敏感菌株(MIC＞4μg／ml)应用琼脂平板法测试。3．对筛选出的万古霉素不敏
[Abstract]:Background: Enterococcus is a conditional pathogen that can cause multiple organ infections, not only urinary tract infection, skin and soft tissue infection, but also life-threatening abdominal infection, septicemia. Endocarditis and meningitis, etc. In recent years, the widespread use of antibiotics has increased the resistance of Enterococcus to 尾 -lactams and high concentrations of aminoglycoside antibiotics, but also to vancomycin resistant Enterococcus. The emergence of multidrug resistant Enterococcus has caused great difficulties in clinical treatment. Therefore, it should be paid more attention to in the United States Centers for Disease Control and Control (CDC) is listed as the second nosocomial infection pathogen, mainly caused by nosocomial infection. Outbreaks mostly occur in intensive care units (ICU) and blood tumor rooms and other patients with critical diseases and low immune function, resulting in a high incidence of infection and mortality. There are mainly five genotypes of vancomycin resistance of Enterococcus to vancomycin:: VanAn VanBor VanCor Van DX VanE. Clinical VRE mostly belong to VanA resistant VRE with high level of vancomycin resistance to vancomycin. The MIC of vancomycin resistance to vancomycin is 64 ~ 512mg / L ~ (-1) / L ~ (-1) VanA which can be induced by vancomycin and teicoplanin. This type of drug-resistant strains are found in Enterococcus faecium and Enterococcus faecalis. The resistance to teicoplanin was sensitive to teicoplanin, and the resistance to vancomycin was different from that of panotoxin, and the resistance to vancomycin in Enterococcus faecium and Enterococcus faecalis showed a natural low level of resistance to vancomycin. Sensitive to teicoplanin. The genotyping and identification of vancomycin resistant Enterococcus is of great significance for its epidemiological analysis and infection control. In recent years, with the development of molecular biological technology, PCR has been applied to the genotyping and related research of vancomycin resistant enterococcus. Objective: to investigate the resistance of Enterococcus to vancomycin, to detect the phenotypes and genotypes of vancomycin resistant Enterococcus, and to study the resistance of Enterococcus to vancomycin. To control nosocomial infection and carry out epidemiological investigation. Methods: 1.The minimal inhibitory concentration (MIC) of 9 antimicrobial agents was determined by broth dilution method for 165 strains of Enterococcus isolated from children's hospital of Jiangxi Province. MIC > 4 渭 g / ml of vancomycin insensitive strain was used. Plate test. 3. Not sensitive to the screened vancomycin
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R378.1

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