尿路感染患者耐碳青霉烯类肠杆菌目细菌耐药基因特征分析

路秀芳; 康亚丽; 李霞; 胡金鼎; 田金静

doi:10.16766/j.cnki.issn.1674-4152.003711

尿路感染患者耐碳青霉烯类肠杆菌目细菌耐药基因特征分析

doi: 10.16766/j.cnki.issn.1674-4152.003711

聊城市第二人民医院检验科，山东聊城 252600

基金项目:

山东省医药卫生科技发展计划项目 202211000916

详细信息

通讯作者:
田金静，E-mail：1209408045@qq.com

中图分类号: R378.2R691.3
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- 文章访问数: 23
- HTML全文浏览量: 12
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-23
- 网络出版日期: 2024-12-28

The gene characteristics of carbapenem-resistant enterobacteriaceae in patients with urinary tract infection

Department of Clinical Laboratory, the Second People ' s Hospital of Liaocheng, Liaocheng, Shandong 252600, China

摘要

摘要: 目的探讨尿路感染患者耐碳青霉烯类肠杆菌目细菌(CRE)的耐药性及耐药基因特征，为本地区CRE防治提供依据。方法收集2017年1月—2022年12月聊城市第二人民医院尿路感染患者细菌培养分离的81株CRE的临床资料，分析其耐药性及耐药基因特征。结果 81株CRE中，大肠埃希菌占比55.56%(45/81)，肺炎克雷伯菌占比28.40%(23/81)。CRE对多黏菌素、替加环素呈现较低耐药率[4.94%(4/81)、0]；大肠埃希菌对头孢他啶/阿维巴坦耐药率高达84.44%(38/45)，而肺炎克雷伯菌对其呈现较低耐药率[8.70%(2/23)]。81株CRE中分型为bla_KPC 22株，均为bla_KPC-2；bla_NDM 59株，其中57株bla_NDM-5，2株bla_NDM-1。大肠埃希菌的耐药基因主要为bla_NDM-5型[97.78%(44/45)]，肺炎克雷伯菌的耐药基因主要为bla_KPC-2型[95.65%(22/23)]。23株碳青霉烯耐药肺炎克雷伯菌(CRKP)ST型以ST11为主[86.96%(20/23)]，45株碳青霉烯耐药大肠埃希菌(CREC)ST型以ST410为主[51.11%(23/45)]。结论尿路感染患者CRE对多种抗菌药物耐药率较高，大肠埃希菌的耐药基因主要为bla_NDM-5型，bla_KPC-2型为肺炎克雷伯菌的主要耐药基因，ST分型主要为ST11型。
- 尿路感染 /
- 肠杆菌目 /
- 碳青霉烯类耐药基因 /
- 药敏分析
Abstract: Objective To explore the drug resistance and gene characteristics of carbapenem-resistant Enterobacteriaceae (CRE) in patients with urinary tract infection, and to provide reference for the prevention and treatment of CRE in this area. Methods Clinical data of 81 strains of CRE isolated from urinary tract infection patients in the Second People ' s Hospital of Liaocheng from January 2017 to December 2022 were collected, and their drug resistance and resistance gene characteristics were analyzed. Results Among the 81 strains of CRE, Escherichia coli accounted for 55.56% (45/81) and Klebsiella pneumoniae accounted for 28.40% (23/81). The drug resistance rates of CRE to polycolistin and tigecycline were lower [4.94% (4/81), 0]. The resistance rate of Escherichia coli to ceftazidime/avibactam was as high as 84.44% (38/45), while the resistance rate of Klebsiella pneumoniae to ceftazidime/avibactam was 8.70% (2/23). Among 81 CRE strains, 22 were bla_KPC, and all were bla_KPC-2. There were 59 strains of bla_NDM, including 57 bla_NDM-5 and 2 bla_NDM-1. The main resistance gene of Escherichia coli was bla_NDM-5 [97.78% (44/45)], and that of Klebsiella pneumoniae was bla_KPC-2 [95.65% (22/23)]. ST11 dominated the ST type of 23 strains of carbapenem-resistant Klebsiella pneumoniae [CRKP, 86.96% (20/23)], and ST410 dominated the ST type of 45 strains of carbapenem-resistant Escherichia coli [CREC, 51.11% (23/45)]. Conclusion The resistance rate of CRE in patients with urinary tract infection was higher, bla_NDM-5 was the main resistance gene of Escherichia coli, bla_KPC-2 was the main resistance gene of Klebsiella pneumoniae, and ST11 was the main ST type.
- Urinary tract infection /
- Enterobacteriaceae /
- Carbapenem resistance gene /
- Drug susceptibility analysis

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表 1 81株CRE的药敏试验耐药率结果[例(%)]

Table 1. Results of drug resistance rate in drug susceptibility test of 81 strains of CRE[cases (%)]

抗菌药物	全部CRE菌株(n=81)	大肠埃希菌(n=45)	肺炎克雷伯菌(n=23)
亚胺培南	65(80.25)	34(75.56)	19(82.61)
美罗培南	69(85.19)	38(84.44)	20(86.96)
阿米卡星	37(45.68)	10(22.22)	17(73.91)
头孢替坦	65(80.25)	37(82.22)	17(73.91)
头孢他啶	78(96.30)	44(97.78)	23(100.00)
头孢吡肟	72(88.89)	43(95.56)	19(82.61)
头孢曲松	80(98.77)	44(97.78)	23(100.00)
头孢哌酮/舒巴坦	78(96.30)	44(97.78)	23(100.00)
哌拉西林/他唑巴坦	67(82.72)	33(73.33)	21(91.30)
磷霉素	80(98.77)	45(100.00)	22(95.65)
氨曲南	68(83.95)	35(77.78)	22(95.65)
环丙沙星	79(97.53)	44(97.78)	23(100.00)
左氧氟沙星	79(97.53)	44(97.78)	22(95.65)
庆大霉素	67(82.71)	36(80.00)	20(86.96)
多黏菌素	4(4.94)	4(8.89)	0
替加环素	0	0	0
头孢他啶/阿维巴坦	40(49.39)	38(84.44)	2(8.70)

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表 2 81例尿路感染患者的临床特征

Table 2. Clinical features of 81 patients with urinary tract infection

项目	类别	例数(%)
性别	男性	58(71.60)
	女性	23(28.40)
基础疾病	糖尿病	15(18.52)
	高血压	29(35.80)
	高脂血症	9(11.11)
	肾脏疾病	11(13.58)
	肿瘤	2(2.47)
	肺部疾病	5(6.17)
预后	好转	43(53.09)
	死亡	17(20.99)
	放弃治疗	21(25.93)
抗菌药物应用	碳青霉烯类	47(58.02)
	酶抑制剂类	43(53.09)
	头孢菌素类	16(19.75)
	喹诺酮类	32(39.51)
	氨基糖苷类	7(8.64)
侵入性操作		72(88.89)

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表 3 81株CRE耐药基因型分布[例(%)]

Table 3. Distribution of the drug resistance-related genes from 81 strains of CRE[cases (%)]

菌名	bla_NDM		bla_KPC(bla_KPC-2)
菌名	bla_NDM-5	bla_NDM-1	bla_KPC(bla_KPC-2)
大肠埃希菌(n=45)	44(97.78)	1(2.22)	0
肺炎克雷伯菌(n=23)	0	1(4.35)	22(95.65)
阴沟肠杆菌(n=5)	5(100.00)	0	0
奇异变形杆菌(n=3)	3(100.00)	0	0
产酸克雷伯杆菌(n=3)	3(100.00)	0	0
产气肠杆菌(n=2)	2(100.00)	0	0
合计(n=81)	57(70.37)	2(2.47)	22(27.16)

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