论文部分内容阅读
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。
Objective To investigate the infection characteristics, drug sensitivity and carbapenemase resistance of carbapenem-resistant enterobacteriaceae (CRE) in Lishui Central Hospital. Methods Clinical data of 140 strains of CRE from Lishui Central Hospital between March 2011 and December 2015 were collected and analyzed. Vitek 2-Compact bacteria and KB paper were used for drug susceptibility testing. Modified Hodge test was used to detect C Enzyme phenotype PCR amplification of common carbapenemase genes KPC, IMP, VIM, NDM and OXA-48. Results 140 strains of CRE were mainly Klebsiella pneumonia (70.71%), followed by Enterobacter aerogenes (6.44%) and Enterobacter cloacae (5.71%). The main source of sputum samples (69.29%), followed by urine (12.86%), secretions and blood (4.29% each). The distribution of clinical departments mainly intensive care unit (accounting for 44.29%), followed by neurosurgery (18.57%) and Department of Hematology (5.00%). The result of drug susceptibility suggested that CRE was highly resistant to most β-lactam drugs with a resistance rate of> 80% and resistance rates to minocycline and amikacin of 14.78% and 35.43%, respectively. Modified Hodge test has 127 positive (positive rate of 90.71%). PCR amplification and sequencing showed that 99 strains carried KPC-2 gene, 14 strains carried IMP-4 gene, 2 strains carried IMP-1 gene and 13 strains carried NDM-1 gene. Conclusions CRE is highly resistant to various antimicrobial agents. KPC is the major drug resistance gene, followed by IMP and NDM. According to the results of drug susceptibility, CRE should be selected appropriately for antimicrobial agents, so as to prevent and control drug-resistant strains The spread and popularity.