碳青霉烯类耐药肠杆菌科细菌的耐药机制研究及其在医院感染控制中的应用

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碳青霉烯类耐药肠杆菌科细菌的耐药机制研究及其在医院感染

控制中的应用

李虹;黄家遂;王洁;兰玉

【期刊名称】《检验医学与临床》 【年(卷),期】2017(014)023

【摘 要】Objective To investigate the drug resistance mechanism of carbapenem-resistant Enterobacteriaceae(CRE) in nosocomial infection control.Methods From January 2012 to December 2013,a total of 5 604 strains of Enterobacteriaceae isolated from our hospital,and 100 strains of bacteria were also isolated,which meropenem antibacterial ring diameter were less than or equal to 20 mm.And the antimicrobial test identified CRE were 11 strains by resistance test.Using the broth microdilution method,the modified Hodge test,IPM EDTA composite susceptibility test,IPM-EDTA double disk test,ESBLs confirmatory test and AmpC test,multidrug resistance gene was screened out,and PCR was used to detect carbapenemase gene sequencing.Results CRE strains were resistant to penicillins,cephalosporins,carbapenems and cefoxitin,the differences were not statistically significant (P＞ 0.05).PCR sequencing results showed that there were 6 bla IMP positive strains,which were all belong to IMP-4 type.And there were 3 bla KPC positive strains,which were all belonging to KPC-2 type.Bacterial resistance gene detection results showed that there was one strain carrying two carbapenemase gene of


Klebsiellapneumonia,Kpn6617,the rest strains were all negative.Conclusion Producing IMP4 is the most common reason that bacteria resistant to carbapenem.Attention should be payed to the characteristics of bacterial resistance of drug-resistant infections in hospital,and thus to provide clinical reference.%目的 探讨碳青霉烯类耐药肠杆菌科细菌(CRE)的耐药机制及其在医院感染控制中的作用.方法 选取2012年1月至2013年12月某院分离得到的肠杆菌科细菌5 604株,美罗培南抑菌环直径小于或等于20 mm的细菌100株,经抗菌药物试验鉴定证实CRE共11株,进行耐药试验;使用微量肉汤法、改良Hodge试验、亚胺培南-乙二胺四乙酸(IPM-EDTA)复合纸片试验、IPM-EDTA双纸片试验、超广谱β-内酰胺酶(ESBLs)确证试验及AmpC试验来筛选耐药基因,应用PCR检测碳青霉烯酶的基因及阳性产物测序.结果 CRE菌株对头孢菌素类、青霉素类、碳青霉烯类及头孢西丁类等抗菌药物都表现出一定程度的耐药性,差异无统计学意义(P＞0.05);PCR测序结果显示,blaIMP阳性菌株6株,均属于IMP-4型;blaKPC阳性菌株3株,均为KPC-2型;细菌耐药基因检测结果方面,筛查出1株携带2种碳青霉烯酶基因的肺炎克雷伯菌Kpn6617,其余筛查结果为阴性.结论 产生碳青霉烯酶是细菌耐药的主要原因,IMP-4是主要酶型;应重视医院感染细菌耐药性特点,从而为临床合理用药提供参考. 【总页数】3页(P3503-3505) 【作 者】李虹;黄家遂;王洁;兰玉

【作者单位】四川省遂宁市中心医院院感科 629000;四川省遂宁市中心医院院感科 629000;四川省遂宁市中心医院院感科 629000;四川省遂宁市中心医院院感科 629000


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