[1]王婷婷,李冬冬,陶传敏,等.对碳青霉烯类抗生素敏感性降低的肠杆菌科细菌产酶机制分析[J].南方医科大学学报,2013,(11):1600.
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对碳青霉烯类抗生素敏感性降低的肠杆菌科细菌产酶机制分析()
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《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2013年11期
页码:
1600
栏目:
出版日期:
2013-11-15

文章信息/Info

Title:
Analysis of the carbapenemase-producing mechanism of Enterobacteriaceae with decreased susceptibility to carbapenems
作者:
王婷婷李冬冬陶传敏谢轶康梅陈知行
关键词:
肠杆菌科碳青霉烯类碳青霉烯酶KPC耐药性
Keywords:
Enterobacteriaceae Carbapenems carbapenemase KPC resistance
摘要:
目的了解临床分离肠杆菌菌种分布及对碳青霉烯类抗菌药物的耐药现状和分子机制。方法收集四川大学华西医院
2009~2010年分离到的对碳青霉烯类药物敏感性降低的肠杆菌科非重复菌株共45株,测定其对常用抗菌药物的最低抑菌浓度
(MIC)以及产酶表型和PCR检测产酶分子机制。结果对碳青霉烯类药物敏感性降低的45株肠杆菌科细菌中,17株菌对亚胺
培南中介或耐药,21株对美罗培南中介或耐药,36株对厄他培南中介或耐药,绝大多数菌株对头孢菌素类耐药。受试菌株中改
良Hodge试验阳性检出率最高(77.8%),其次为EDTA纸片增效试验(57.8%)和PBA纸片增效试验(22.2%)。blaTEM、blaSHV
和blaCTX-M基因检出率分别为60.0%,53.3%和15.6%,同时携带2 种及以上基因的检出率为44.4%。blaIMP 基因检出率为
48.9%。4株菌(3株产酸克雷伯菌,1株阴沟肠杆菌)为blaKPC基因阳性,检出率为8.9%,且位于质粒上。结论研究发现肠杆菌
科细菌产酶是对碳青霉烯类药物敏感性下降的主要机制,产碳青霉烯酶或合并多种β-内酰胺酶可引起非敏感或耐药的出现。
本研究报道了在西南地区发现在质粒携带的KPC-2型酶,可能引起不同菌种间水平传播,需引起足够重视。
Abstract:
Objectives To analyze the distribution of Enterobacteriaceae isolated from West China Hospital, investigate the
antibiotic resistance profile of Enterobacteriaceae with decreased susceptibility to carbapenems and explore the molecular
mechanism. Methods Forty-five Enterobacteriaceae strains resistant or with reduced susceptibility to carbapenems were
isolated from patients in West China Hospital. The antimicrobial susceptibility and carbapenemase-producing phenotypes of
the bacteria were examined and specific PCR were performed to determine the molecular mechanism. Results Of the 45
isolates, 17, 21 and 36 were resistant or intermediate strains to imipenem, meropenem and ertapenem, respectively. The
majority of these isolates showed resistance to cephalosporins. The modified Hodge test resulted in the highest positivity rate
(77.8%), followed by EDTA disc test (57.8%) and PBA disc test (22.2%). BlaTEM, blaSHV and blaCTX-M were detected in
60.0%, 53.3% and 15.6% of these strains with reduced susceptibility. The rate of strains carrying 2 or more genes was 44.4%,
and the detection rate of blaIMP was 48.9%. BlaKPC was identified in 4 (8.9%) high-level resistant strains and confirmed to
locate on the plasmid. Conclusion Production of carbapenemase contributes to reduced susceptibility of carbapenems in
Enterobacteriaceae. The presence of blaKPC, MBL and ESBL, and their possible combinations can be the main factor contributing
to carbapenem resistance or reduced susceptibility in Enterobacteriaceae. The KPC-2 carbapenemase gene located on the
plasmids we found in this study can cause potential horizontal transmission across strains.
更新日期/Last Update: 1900-01-01