泌尿系感染多重耐药肠杆菌科细菌分子流行病学分析

发布时间：2018-02-03 13:06

本文关键词： 泌尿系疾病肠杆菌科感染分子流行病学　出处：《中国全科医学》2015年11期 　论文类型：期刊论文

【摘要】：目的了解海南地区泌尿系感染多重耐药肠杆菌科细菌的流行特点及耐药机制。方法收集海南地区4家三级综合医院(海南省人民医院、海口市人民医院、海南农垦总局医院和三亚市人民医院)2012年1月—2013年8月门诊和住院泌尿系感染患者清洁中段尿分离的多重耐药肠杆菌科细菌225株,采用VITEK 2 compact微生物分析仪进行细菌鉴定和药敏试验,采用确证试验检测超广谱β-内酰胺酶(ESBLs),采用改良Hodge试验(MHT)和金属酶筛选(MBL)试验对碳青霉烯类不敏感菌株进行碳青霉烯酶表型确认,对于阳性菌株采用PCR扩增分别进行ESBLs、KPC酶、IPM酶和NDM-1基因型检测,并对扩增产物进行测序。结果 225株多重耐药肠杆菌科细菌中产ESBLs的细菌203株(90.2%),其中大肠埃希菌163株、肺炎克雷伯菌32株、产酸克雷伯菌4株、奇异变形杆菌4株;其他多重耐药肠杆菌科细菌22株(9.8%)。药敏试验发现对碳青霉烯类不敏感的细菌有26株,行MHT有11株阳性,MBL试验有8株阳性。经PCR扩增对阳性菌株进行基因检测,结果 3株携带KPC-2基因,5株携带NDM-1基因,1株携带IPM-4基因。ESBLs基因型中TEM型占60.1%(122/203)、CTX-M型占46.3%(94/203)、SHV型占15.8%(32/203),有39株细菌同时扩增出2种及以上基因型。结论海南地区泌尿系感染多重耐药肠杆菌科细菌主要以产ESBLs的大肠埃希菌和肺炎克雷伯菌为主,流行的基因型以TEM型多见,其次是CTX-M型和SHV型;已发现少量对碳青霉烯类不敏感菌株,其主要耐药机制为产生NDM-1、KPC-2、IPM-4基因,临床上应引起重视,严格做好预防和控制工作。
[Abstract]:Objective to investigate the epidemic characteristics and drug resistance mechanism of enterobacteriaceae in urinary tract infection in Hainan area. Methods four tertiary general hospitals (Hainan Provincial people's Hospital, Haikou people's Hospital) were collected. Hainan General Administration of Agriculture and Reclamation Hospital and Sanya Municipal people's Hospital) from January 2012 to August 2013, 225 strains of multidrug-resistant Enterobacteriaceae were isolated from the clean middle section of urine in outpatients and inpatients with urinary tract infection. Bacterial identification and drug sensitivity test were carried out by VITEK 2 compact microbiological analyzer. Extended-spectrum 尾 -lactamases (ESBLs) were detected by confirmatory test. The phenotypes of carbapenem insensitive strains were identified by modified Hodge test and metal enzyme screening test. PCR amplification was used to detect ESBLsKCP-IPMase and NDM-1 genotypes, respectively. The amplified products were sequenced. Results among 225 strains of multidrug resistant Enterobacteriaceae, 203 strains produced ESBLs, including 163 strains of Escherichia coli. 32 strains of Klebsiella pneumoniae, 4 strains of Klebsiella acidogenic bacteria, 4 strains of Proteus mirabilis; Other 22 strains of Enterobacteriaceae were found to be insensitive to carbapenem and 11 strains were positive for MHT. There were 8 positive strains in MBL test. The positive strains were detected by PCR amplification. The results showed that 3 strains carried KPC-2 gene and 5 strains carried NDM-1 gene. TEM genotype accounted for 60.1% of the alleles carrying IPM-4 gene. CTX-M genotype accounted for 46.3%. SHV type accounted for 15.8% / 32 / 203). Two or more genotypes were amplified from 39 strains of bacteria at the same time. Conclusion ESBLs producing Escherichia coli and Klebsiella pneumoniae are the main bacteria in the multidrug-resistant enterobacteriaceae of urinary tract infection in Hainan area. The most prevalent genotypes were TEM, followed by CTX-M and SHV. A few strains insensitive to carbapenes have been found, and the main drug resistance mechanism is the production of NDM-1, KPC-2, IPM-4 gene. Therefore, attention should be paid to the prevention and control work.
【作者单位】：海南省海口市疾病预防控制中心;海口市人民医院;广州医科大学附属第一医院;
【基金】：海口市重点科技计划项目(2012-070)
【分类号】：R446.5
【正文快照】： Urinary System Infection of Multidrug-resistant Enterobacteriaceae:A Molecular Epidemiology Analysis YUN Chang-ying,WU Duo-rong,HUANG Hui,et al.Haikou Center for Disease Control and Prevention,Haikou 571100,ChinaIn Hainan District,multidrug-resistant ent

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