CAJ | 학술논문

目的：研究临床分离的1株植生拉乌尔菌对碳青霉烯类抗生素的耐药机制。方法2010年11月四川省人民医院骨科1例患者的引流液分离出1株植生拉乌尔菌。采用琼脂稀释法测定菌株对13种抗菌药物的MIC；用改良Hodge试验检测碳青霉烯酶；EDTA协同试验检测金属酶β内酰胺酶；PCR扩增检测A类碳青霉烯酶（ KPC）、B类碳青霉烯酶（ NDM、IMP、VIM、SIM）、超广谱β内酰胺酶[ESBL（CTX、TEM、SHV）]和AmpC酶（FOX、EBC、ACC、DHA、CIT、MOX）基因。结果药物敏感性试验显示菌株对包括碳青霉烯类抗生素在内的9种抗生素均耐药，对美罗培南的MIC高达32 mg/L。该菌仅对亚胺培南保持中介，对头孢吡肟、阿米卡星和多黏菌素B敏感。菌株的改良Hodge试验和EDTA协同试验均为阳性。 PCR扩增B类碳青霉烯酶基因IMP和2种ESBLs基因CTX、SHV为阳性，其PCR产物经测序后同GenBank数据库比对后证实分别为IMP-4、CTX-M3和SHV-12。其余耐药基因均为阴性。结论在植生拉乌尔菌中检测出IMP-4，且IMP-4合并产ESBLs可能是该菌株对碳青霉烯类抗生素耐药的主要机制之一。（中华检验医学杂志，2014，37：459-462）
목적：연구림상분리적1주식생랍오이균대탄청매희류항생소적내약궤제。방법2010년11월사천성인민의원골과1례환자적인류액분리출1주식생랍오이균。채용경지희석법측정균주대13충항균약물적MIC；용개량Hodge시험검측탄청매희매；EDTA협동시험검측금속매β내선알매；PCR확증검측A류탄청매희매（ KPC）、B류탄청매희매（ NDM、IMP、VIM、SIM）、초엄보β내선알매[ESBL（CTX、TEM、SHV）]화AmpC매（FOX、EBC、ACC、DHA、CIT、MOX）기인。결과약물민감성시험현시균주대포괄탄청매희류항생소재내적9충항생소균내약，대미라배남적MIC고체32 mg/L。해균부대아알배남보지중개，대두포필우、아미잡성화다점균소B민감。균주적개량Hodge시험화EDTA협동시험균위양성。 PCR확증B류탄청매희매기인IMP화2충ESBLs기인CTX、SHV위양성，기PCR산물경측서후동GenBank수거고비대후증실분별위IMP-4、CTX-M3화SHV-12。기여내약기인균위음성。결론재식생랍오이균중검측출IMP-4，차IMP-4합병산ESBLs가능시해균주대탄청매희류항생소내약적주요궤제지일。（중화검험의학잡지，2014，37：459-462）
Objective To investigate the mechanism of one carbapenems resistant Raoultella planticola( R.planticola) isolate.Methods This is an experimental study.R.planticola was isolated from a patient′s drainage fluid from orthopedic department in November 2010 in Sichuan Provincial People′s Hospital.Minimum inhibitory concentration of R.planticola to 13 antibiotics was determined by using the agar dilution method.Modified Hodge test was used to detect carbapenemase .EDTA synergistic test was performed to research metallo-beta-lactamase.The genes coded the β-lactamase were amplified by polymerase chain reaction ( PCR ) , including class A carbapenemase ( KPC ) , class B carbapenemases (NDM, IMP, VIM, SIM), extended spectrum beta-lactamases[ESBL(CTX, TEM, SHV)], and AmpCβ-lactamases ( FOX, EBC, ACC, DHA, CIT, MOX).Results The susceptibility test showed that R.planticola was resistant to 9 antibiotics.MIC value of meropenem for R.planticola was up to 32 mg/L.R.planticola kept intermediary to imipenem , whereas it was susceptible to cefepime , amikacin and polymyxin B.Modified Hodge test and EDTA synergistic test were positive in R.planticola.Class B carbapenemase (IMP) gene and two extended spectrum β-lactamases(CTX, SHV) genes were positive by PCR.The genes were conformed as IMP-4, CTX-M3 and SHV-12 by sequencing and compared with GenBank.Other resistant genes were negative.Conclusion IMP-4 was identified in R.planticola, the combined produce IMP-4 and ESBLs might be the main mechanism of R.planticola resistant to carbapenems.