Characteristics of carbapenem-resistance Enterobacteriaceae infection in our hospital and genotypic analysis of carbapenemase genes
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摘要: 目的 研究丽水市中心医院耐碳青霉烯类肠杆菌科细菌(CRE)的感染特点、药物敏感性和碳青霉烯酶基因携带情况。 方法 收集2011年3月—2015年12月期间丽水市中心医院共140株CRE的临床资料并分析,Vitek 2-Compact鉴定细菌,K-B纸片法进行药物敏感性试验,改良Hodge试验检测碳青霉烯酶表型,PCR扩增常见的碳青霉烯酶基因KPC、IMP、VIM、NDM和OXA-48。 结果 140株CRE以肺炎克雷伯菌为主(占70.71%),其次为产气肠杆菌(占6.44%)和阴沟肠杆菌(占5.71%)。标本来源以痰液为主(占69.29%),其次为尿液(占12.86%)、分泌物和血液(均各占4.29%)。临床科室分布以重症监护室为主(占44.29%),其次为神经外科(占18.57%)和血液内科(占5.00%)。药敏结果提示CRE对大部分β内酰胺类药物高度耐药,耐药率>80%,对米诺环素、阿米卡星的耐药率分别为14.78%和35.43%。改良Hodge试验有127株阳性(阳性率为90.71%)。PCR扩增及基因测序比对结果提示99株携带KPC-2基因,14株携带IMP-4基因,2株携带IMP-1基因,13株携带NDM-1基因。 结论 CRE对多种抗菌药物高度耐药,耐药基因以KPC为主,其次为IMP和NDM,临床应根据药物敏感性结果合理选用抗菌药物,做好院感监测及防护,以防止耐药菌株的传播和流行。Abstract: Objective To investigate the characteristics and drug sensitivity of carbapenem-resistance Enterobacteriaceae (CRE) infection in our hospital, and study the genotypic analysis of carbapenemase genes. Methods A total of 140 strains of CRE were collected and the epidemiological date were analyzed. CRE were identified by using VITEK 2-Compact bacterial identification system, the antibiotics-sensitivity were tested by kirby-bauer disk susceptibility test, carbapenemase production was detected by the Modified Hodge Test (MHT), and the carbapenemase genes (KPC, IMP, VIM, NDM, OXA-48) were detected by PCR technology. Results Klebsiella pneumoniae was dominated in all CRE, accounting for 70. 71%, followed by Enterobacter aerogenes (6. 44%) and Enterobacter cloacae (5. 71%). CRE samples were mainly isolated from sputum, accounting for 69. 29%, followed by urine (12. 86%), secretion (4. 29%) and blood (4. 29%). The most of the patients were from ICU, accounting for 44. 29% and followed by neurosurgery (18. 57%) and hematology (5. 00%). The drug sensitivity test showed CRE were high resistant to most of β-lactam antibiotics, the resistant rate was higher than 80%, the resistant rate to minocyline and amikacin were 14. 78% and 35. 43%, respectively.Modified Hodge test showed 127 strains were positive. PCR and gene sequencing showed 99 strains CRE carrying KPC-2, 14 strains carrying IMP-4, 2 strains carrying IMP-1 and 13 strains carrying NDM-1. Conclusion CRE is highly resistant to most antibiotics in our hospital, and the main resistant gene is KPC, followed by IMP and NDM. According to susceptibility test, the hospital should enhance the drug-resistance surveillance and use antibiotics reasonable to control the multi-drug resistance and the prevalence of resistant strains.
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Key words:
- Carbapenemase /
- Enterobacteriaceae /
- Drug resistance
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