耐碳青霉烯革兰阴性杆菌耐药性及耐药基因blaKPC的分子特征
作者:
作者单位:

作者简介:

薛云

通讯作者:

中图分类号:

R378

基金项目:

国家自然科学基金(U1704117、31302106)


Drug resistance of carbapenem-resistant Gram-negative bacilli and molecular characteristics of drug resistance gene blaKPC
Author:
Affiliation:

Fund Project:

  • 摘要
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 文章评论
    摘要:

    目的 探讨耐碳青霉烯类革兰阴性杆菌的临床耐药性及耐药基因blaKPC的分子特征。方法 分析2017年1月-2018年12月某院临床检出的耐碳青霉烯类革兰阴性杆菌。通过WHONET 5.6软件对药物敏感试验数据进行统计分析,采用PCR检测碳青霉烯耐药基因blaKPC、blaNDM、blaIMP、blaVIM、blaOXA-48,对PCR阳性产物进行DNA测序,分析耐药基因的分子结构特点。结果 共收集510株耐碳青霉烯类革兰阴性杆菌,其中耐碳青霉烯类肠杆菌科细菌(CRE)420株,耐碳青霉烯非肠杆菌科细菌90株。菌株主要来自重症监护病房(ICU)、神经外科和呼吸科,分别占60.8%、11.8%、5.3%;标本来自痰、脓性分泌物、静脉血、无菌中段尿,分别占66.9%、8.8%、8.2%、6.5%。耐碳青霉烯类革兰阴性杆菌对常用抗菌药物具有较高的耐药性。PCR结果显示,420株CRE中blaKPC、blaNDM、blaIMP的阳性率分别为54.3%(228/420)、1.2%(5/420)、1.4%(6/420),未检测出blaVIM和blaOXA-48基因,其中肺炎克雷伯菌、产气肠杆菌、大肠埃希菌分别占携带blaKPC CRE的83.8%、11.8%、2.6%;其他少见菌种中也检出blaKPC基因。非肠杆菌科细菌中仅有2株鲍曼不动杆菌检测出blaKPC。DNA测序结果显示,174株携带blaKPC的菌株中173株检测为blaKPC-2、1株检测为blaKPC-1。结论 该地区耐碳青霉烯类革兰阴性菌以CRE为主,其中以携带blaKPC-2的肺炎克雷伯菌占绝对优势,其他菌株中也均有发现。提示临床需重点加强耐碳青霉烯类肺炎克雷伯菌的监测及预防,防控blaKPC的传播流行。

    Abstract:

    Objective To investigate the clinical drug resistance of carbapenem-resistant Gram-negative bacilli and molecular characteristics of drug resistance gene blaKPC. Methods Clinically isolated carbapenem-resistant Gram-negative bacilli in a hospital from January 2017 to December 2018 were analyzed. Antimicrobial susceptibility testing data were statistically analyzed by WHONET 5.6 software, carbapenem-resistant genes blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48 were detected by polymerase chain reaction (PCR), PCR positive products were performed DNA sequence to analyze the molecular structure of drug resistance genes. Results A total of 510 strains of carbapenem-resistant Gram-negative bacilli were collected, including 420 strains of carbapenem-resistant Enterobacteriaceae (CRE) and 90 strains of carbapenem-resistant non-Enterobacteriaceae. Strains were mainly from intensive care unit (ICU), departments of neurosurgery and respiratory, accounting for 60.8%, 11.8% and 5.3% respectively; specimens were from sputum, purulent secretion, venous blood, and sterile midstream urine, accounting for 66.9%, 8.8%, 8.2% and 6.5% respectively. Carbapenem-resistant Gram-negative bacilli were highly resistant to commonly used antimicrobial agents. PCR results showed that among 420 strains of CRE, positive rates of blaKPC, blaNDM, and blaIMP were 54.3% (228/420), 1.2% (5/420), and 1.4% (6/420) respectively. blaVIM and blaOXA-48 genes were not found, Klebsiella pneumoniae, Enterobacter aerogenes, and Escherichia coli accounted for 83.8%, 11.8%, and 2.6% of blaKPC-carrying CRE respectively; blaKPC was also detected in other rare strains. blaKPC was detected in only 2 strains of Acinetobacter baumannii in non-Enterobacteriaceae. DNA sequencing showed that among 174 strains carrying blaKPC, 173 strains were found blaKPC-2 and 1 strain was found blaKPC-1. Conclusion CRE is the main Gram-negative bacteria resistant to carbapenems in this area, dominantly Klebsiella pneumoniae carrying blaKPC-2, and other strains are also found. It is suggested that the monitoring and prevention of carbapenem-resistant Klebsiella pneumoniae should be strengthened to prevent and control the spread of blaKPC.

    参考文献
    相似文献
引用本文

王珍珍, 赵战勤, 常永超,等.耐碳青霉烯革兰阴性杆菌耐药性及耐药基因blaKPC的分子特征[J]. 中国感染控制杂志,2020,19(10):857-863. DOI:10.12138/j. issn.1671-9638.20205847.
WANG Zhen-zhen, ZHAO Zhan-qin, CHANG Yong-chao, et al. Drug resistance of carbapenem-resistant Gram-negative bacilli and molecular characteristics of drug resistance gene blaKPC[J]. Chin J Infect Control, 2020,19(10):857-863. DOI:10.12138/j. issn.1671-9638.20205847.

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2019-09-28
  • 最后修改日期:
  • 录用日期:
  • 在线发布日期: 2020-10-28
  • 出版日期: