CAJ | 학술논문

目的：了解对碳青霉烯类抗生素耐药的肠杆菌科细菌（CRE）中碳青霉烯酶的主要类型及流行情况。方法收集上海瑞金医院2011年5月至2013年6月对亚胺培南或美罗培南药敏纸片抑菌圈直径≤22 mm的CRE共114株，采用PCR方法扩增常见的碳青霉烯酶基因（blaKPC 、blaIMP 、blaOXA‐48、blaVIM 、blaNDM ）并对PCR扩增产物进行测序；所有菌株均进行了质粒接合试验；采用脉冲场凝胶电泳（PFGE）对KPC‐2检测阳性的肺炎克雷伯菌进行同源性分析。结果114株CRE以肺炎克雷伯菌、大肠埃希菌和肠杆菌属细菌为主，其中98株产碳青霉烯酶，以K PC‐2酶为主要类型（78／98）、其次为IM P‐4酶（15／98）， IMP‐8酶（2／98），1株肺炎克雷伯菌同时携带有 blaKPC‐2和 blaIMP‐4基因，还发现4株产 NDM‐1酶的菌株，未见OXA‐48酶及VIM酶阳性菌株。21株（21．4％，21／98）CRE菌株转移接合试验成功。PFGE结果显示49株 blaKPC‐2阳性肺炎克雷伯菌共分为12个型，其中34株属于同一谱型（type A ）。CRE菌株主要分离自ICU ，共39株，其次为普外科14株，血液科11株，呼吸科9株，其余科室共41株。结论本次分离的肠杆菌科细菌所产碳青霉烯酶的基因型以blaKPC‐2为主，其次为blaIMP‐4，并发现4株blaNDM‐1阳性CRE菌株，产KPC‐2酶的肺炎克雷伯菌在外科ICU、呼吸科及胸外科等科室间存在克隆株的流行传播，应采取及时有效的防控措施。
목적：료해대탄청매희류항생소내약적장간균과세균（CRE）중탄청매희매적주요류형급류행정황。방법수집상해서금의원2011년5월지2013년6월대아알배남혹미라배남약민지편억균권직경≤22 mm적CRE공114주，채용PCR방법확증상견적탄청매희매기인（blaKPC 、blaIMP 、blaOXA‐48、blaVIM 、blaNDM ）병대PCR확증산물진행측서；소유균주균진행료질립접합시험；채용맥충장응효전영（PFGE）대KPC‐2검측양성적폐염극뢰백균진행동원성분석。결과114주CRE이폐염극뢰백균、대장애희균화장간균속세균위주，기중98주산탄청매희매，이K PC‐2매위주요류형（78／98）、기차위IM P‐4매（15／98）， IMP‐8매（2／98），1주폐염극뢰백균동시휴대유 blaKPC‐2화 blaIMP‐4기인，환발현4주산 NDM‐1매적균주，미견OXA‐48매급VIM매양성균주。21주（21．4％，21／98）CRE균주전이접합시험성공。PFGE결과현시49주 blaKPC‐2양성폐염극뢰백균공분위12개형，기중34주속우동일보형（type A ）。CRE균주주요분리자ICU ，공39주，기차위보외과14주，혈액과11주，호흡과9주，기여과실공41주。결론본차분리적장간균과세균소산탄청매희매적기인형이blaKPC‐2위주，기차위blaIMP‐4，병발현4주blaNDM‐1양성CRE균주，산KPC‐2매적폐염극뢰백균재외과ICU、호흡과급흉외과등과실간존재극륭주적류행전파，응채취급시유효적방공조시。
Objective To investigate the prevalence and main genotypes of carbapenemases in carbepenem‐resistant Enterobacteriaceae (CRE) .Methods A total of 114 strains of CRE were isolated in Shanghai Ruijin Hospital from May 2011 to June 2013 .The diameter of inhibition zone of imipemen or meropenem for these strains was not larger than 22 mm .PCR method was used to screen for the main carbapenemase genes (blaKPC ,blaIMP ,blaVIM ,blaOXA‐48 and blaNDM ) with previously described primers followed by nucleotide sequencing analysis . Conjugation experiments were performed to examine the transferability of plasmids .Pulsed‐field gel electrophoresis (PFGE) was used to show the relatedness of KPC‐2‐producing Enterobacteriaceae .Results Most of the 114 isolates were K lebsiella pneumoniae and Escherichia coli .Of the 114 isolates ,98 was positive for carbapenemases ,specifically ,78 blaKPC‐2‐positive ,15 blaIMP‐4‐positive ,2 blaIMP‐8‐positive ,1 positive for both blaKPC‐2 and blaIMP‐4 and 4 blaNDM‐1‐positive .None of the strains was positive for blaOXA‐48 or blaVIM .About 21 .4% (21/98) of the isolates were conjugated successfully .The 49 blaKPC‐2‐positive K .pneumoniae isolates were grouped into 12 types according to PFGE patterns .Majority (34/49) of these isolates belonged to the same type A .Conclusions BlaKPC‐2 was the primary epidemic genotype of Enterobacteriaceae in Ruijin Hospital ,followed by blaIMP‐4 .NDM‐1 carbapenemase was produced in 4 strains of CRE . Meanwhile , clonal spread of KPC‐2‐producing K . pneumoniae was observed in some departments of our hospital , such as surgical ICU , respiratory medicine and thoracic surgery . Appropriate measures should be taken timely and effectively to prevent the in‐hospital spread of resistant genes .