CAJ | 학술논문

目的：调查医院胸外科分离大肠埃希菌 qnr基因的携带及其与 ISCR之间的相关性，初步探讨 ISCR及qnr基因在大肠埃希菌的传播，为临床治疗提供参考依据。方法收集2010年11月－2014年11月分离出120株非重复耐氟喹诺酮类大肠埃希菌，采用 PCR法检测 qnrA、B、C、D、S基因及 ISCR基因，并对阳性菌株进行ISCR与qnr基因的连锁检测，通过DNA直接测序及质粒接合试验确定qnr及 ISCR基因的传播性。结果120株耐氟喹诺酮类大肠埃希菌中对左氧氟沙星耐药78株、对环丙沙星耐药95株，其中有 qnrA 基因阳性菌株53株，经测序确认均为qnrA1基因，均表现出环丙沙星和左氧氟沙星耐药；基因连锁检测发现，仅43株 ISCR‐qnrA 1连锁检测阳性；43菌株的 qnrA1基因可通过接合传播，同时伴随着 ISCR1‐qnrA 1的共同传播。结论胸外科分离大肠埃希菌对氟喹诺酮类耐药严重，主要存在 qnr基因传播，并与 ISCR1基因之间存在直接的相关性，可通过质粒接合方式进行 ISCR1‐qnrA1水平连锁传播。
목적：조사의원흉외과분리대장애희균 qnr기인적휴대급기여 ISCR지간적상관성，초보탐토 ISCR급qnr기인재대장애희균적전파，위림상치료제공삼고의거。방법수집2010년11월－2014년11월분리출120주비중복내불규낙동류대장애희균，채용 PCR법검측 qnrA、B、C、D、S기인급 ISCR기인，병대양성균주진행ISCR여qnr기인적련쇄검측，통과DNA직접측서급질립접합시험학정qnr급 ISCR기인적전파성。결과120주내불규낙동류대장애희균중대좌양불사성내약78주、대배병사성내약95주，기중유 qnrA 기인양성균주53주，경측서학인균위qnrA1기인，균표현출배병사성화좌양불사성내약；기인련쇄검측발현，부43주 ISCR‐qnrA 1련쇄검측양성；43균주적 qnrA1기인가통과접합전파，동시반수착 ISCR1‐qnrA 1적공동전파。결론흉외과분리대장애희균대불규낙동류내약엄중，주요존재 qnr기인전파，병여 ISCR1기인지간존재직접적상관성，가통과질립접합방식진행 ISCR1‐qnrA1수평련쇄전파。
OBJECTIVE To investigate the relationship of qnr gene carrying and ISCR gene of the fluoroquinolone resistant Escherichia coli (E .coli) from the thoracic surgical department in the hospital to explore the role of oc‐cult transmission of qnr and ISCR in E .coli .METHODS Totally 120 clinical isolates of non‐repetitive fluoroquin‐olone resistant E .coli were collected in the department of thoracic surgery in our hospital from Nov .2010 to Nov . 2014 .QnrA ,gnrB , gnrC , gnrD , gnrS and ISCR genes were detected by PCR .All PCR products were se‐quenced for determination .Plasmid conjugation test and plasmid elimination method were used to determine dis‐semination of qnr and ISCR genes .RESULTS Among 120 fluoroquinolone‐resistant E .coli ,78 strains were re‐sistant to levofloxacin ,95 strains were resistant to ciprofloxacin .There were 53 qnrA gene‐positive strains ,which were confirmed to be qnrA1 gene by sequencing and exhibited co‐resistance to ciprofloxacin and levofloxacin .The gene linkage detection found that only 43 ISCR‐qnrA1 were positive for linkage detection .The 43 qnrA1 positive strains could be spreaded by the conjugative method , accompanied by the spread of ISCR‐qnrA1 gene . CONCLUSION A high prevalence of qnr genes was found among clinical fluoroquinolone‐resistant E .coli isolated from the department of thoracic surgery in our hospital .There was a direct relationship between the qnrA1 gene and the ISCR1 gene .Most of the qnrA1 positive isolates can be transferred by horizontal and vertical dissemina‐tion with clones and plasmid conjugation ,which are co‐transferred with the ISCR1‐qnrA1 gene .