中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
40期
3264-3268
,共5页
赵岐刚%贾秀芹%庞峰%李艳华
趙岐剛%賈秀芹%龐峰%李豔華
조기강%가수근%방봉%리염화
阴沟肠杆菌%碳青霉烯酶%基因型%临床感染
陰溝腸桿菌%碳青黴烯酶%基因型%臨床感染
음구장간균%탄청매희매%기인형%림상감염
Enterobacter cloacae%Carbapenemases%Genotype%Clinical infection
目的 了解医院产碳青霉烯酶阴沟肠杆菌的主要基因型,并对其临床感染特征进行分析,为临床采取积极的防控措施奠定基础.方法 收集2007年1月至2014年12月临床非重复分离的阴沟肠杆菌,筛选碳青霉烯类抗菌药物敏感性降低的菌株,通过改良Hodge试验(MHT)及乙二胺四乙酸(EDTA)协同试验检测碳青霉烯酶表型,PCR 扩增碳青霉烯酶基因型blaKPC、blaIMP、blaVIM、blaOXA-48及blaNDM-1 ,阳性结果进行DNA测序并Blast比对确定分型.对耐碳青霉烯类阴沟肠杆菌进行接合试验,通过药敏试验和基因扩增验证接合情况.同时收集耐药菌株感染患者的临床资料,分析其临床感染流行病学数据.结果 经MHT、EDTA协同试验及PCR扩增测序共检测出产碳青霉烯酶阴沟肠杆菌64株,其中70.3%(45/64)来自院内感染,29.7%(19/64)来自社区感染;64株菌主要分离于分泌物占65.6%(42/64),痰标本占23.4%(15/64),临床分布以骨外科、烧伤科、重症监护室及儿科为主,分别占43.8%、21.9%、18.8%及14.1%;床位变更、侵袭性操作及留置导管是产酶菌株产生的高危因素,产酶株感染患者在细菌分离前住院天数较多,治愈率更低,住院总天数更多,使用头孢类加酶抑制剂复合制剂及碳青霉烯类频次更高(均P<0.05);除多粘菌素及替加环素外,64株菌对常见抗菌药物呈现多重耐药趋势;Blast 比对显示,29 株为blaIMP-4型,35株为blaIMP-8型,未检出blaVIM、blaOXA-48、blaNDM-1基因型;接合试验证实接合子与供体菌具有相似的耐药性,可扩增出相同的耐药基因.结论 阴沟肠杆菌耐药情况日趋严重,IMP-4型和IMP-8 型碳青霉烯酶是菌株产酶的主要型别,耐药基因可通过质粒进行水平传播且已在医院科室中局部流行,必须及时控制耐药菌株产生的高危因素.
目的 瞭解醫院產碳青黴烯酶陰溝腸桿菌的主要基因型,併對其臨床感染特徵進行分析,為臨床採取積極的防控措施奠定基礎.方法 收集2007年1月至2014年12月臨床非重複分離的陰溝腸桿菌,篩選碳青黴烯類抗菌藥物敏感性降低的菌株,通過改良Hodge試驗(MHT)及乙二胺四乙痠(EDTA)協同試驗檢測碳青黴烯酶錶型,PCR 擴增碳青黴烯酶基因型blaKPC、blaIMP、blaVIM、blaOXA-48及blaNDM-1 ,暘性結果進行DNA測序併Blast比對確定分型.對耐碳青黴烯類陰溝腸桿菌進行接閤試驗,通過藥敏試驗和基因擴增驗證接閤情況.同時收集耐藥菌株感染患者的臨床資料,分析其臨床感染流行病學數據.結果 經MHT、EDTA協同試驗及PCR擴增測序共檢測齣產碳青黴烯酶陰溝腸桿菌64株,其中70.3%(45/64)來自院內感染,29.7%(19/64)來自社區感染;64株菌主要分離于分泌物佔65.6%(42/64),痰標本佔23.4%(15/64),臨床分佈以骨外科、燒傷科、重癥鑑護室及兒科為主,分彆佔43.8%、21.9%、18.8%及14.1%;床位變更、侵襲性操作及留置導管是產酶菌株產生的高危因素,產酶株感染患者在細菌分離前住院天數較多,治愈率更低,住院總天數更多,使用頭孢類加酶抑製劑複閤製劑及碳青黴烯類頻次更高(均P<0.05);除多粘菌素及替加環素外,64株菌對常見抗菌藥物呈現多重耐藥趨勢;Blast 比對顯示,29 株為blaIMP-4型,35株為blaIMP-8型,未檢齣blaVIM、blaOXA-48、blaNDM-1基因型;接閤試驗證實接閤子與供體菌具有相似的耐藥性,可擴增齣相同的耐藥基因.結論 陰溝腸桿菌耐藥情況日趨嚴重,IMP-4型和IMP-8 型碳青黴烯酶是菌株產酶的主要型彆,耐藥基因可通過質粒進行水平傳播且已在醫院科室中跼部流行,必鬚及時控製耐藥菌株產生的高危因素.
목적 료해의원산탄청매희매음구장간균적주요기인형,병대기림상감염특정진행분석,위림상채취적겁적방공조시전정기출.방법 수집2007년1월지2014년12월림상비중복분리적음구장간균,사선탄청매희류항균약물민감성강저적균주,통과개량Hodge시험(MHT)급을이알사을산(EDTA)협동시험검측탄청매희매표형,PCR 확증탄청매희매기인형blaKPC、blaIMP、blaVIM、blaOXA-48급blaNDM-1 ,양성결과진행DNA측서병Blast비대학정분형.대내탄청매희류음구장간균진행접합시험,통과약민시험화기인확증험증접합정황.동시수집내약균주감염환자적림상자료,분석기림상감염류행병학수거.결과 경MHT、EDTA협동시험급PCR확증측서공검측출산탄청매희매음구장간균64주,기중70.3%(45/64)래자원내감염,29.7%(19/64)래자사구감염;64주균주요분리우분비물점65.6%(42/64),담표본점23.4%(15/64),림상분포이골외과、소상과、중증감호실급인과위주,분별점43.8%、21.9%、18.8%급14.1%;상위변경、침습성조작급류치도관시산매균주산생적고위인소,산매주감염환자재세균분리전주원천수교다,치유솔경저,주원총천수경다,사용두포류가매억제제복합제제급탄청매희류빈차경고(균P<0.05);제다점균소급체가배소외,64주균대상견항균약물정현다중내약추세;Blast 비대현시,29 주위blaIMP-4형,35주위blaIMP-8형,미검출blaVIM、blaOXA-48、blaNDM-1기인형;접합시험증실접합자여공체균구유상사적내약성,가확증출상동적내약기인.결론 음구장간균내약정황일추엄중,IMP-4형화IMP-8 형탄청매희매시균주산매적주요형별,내약기인가통과질립진행수평전파차이재의원과실중국부류행,필수급시공제내약균주산생적고위인소.
Objective To study the genotypes and clinical characteristics of carbapenemase -producing Enterobacter cloacae (E.cloacae) , and lay the foundation for active control of nosocomial infection.Methods E.cloacae isolates were collected from January 2007 to December 2014.Strains which showed decreased sensitivity to carbapenem were screened out by the modified Hodge test (MHT) and EDTA-disk synergy test.The genotype of blaKPC , blaIMP , blaVIM , blaOXA-48 and blaNDM-1 were detected by PCR amplication, the product of PCR was sequenced and conducted by Blast (http://blast.ncbi.nlm.nih.gov/Blast.cgi).Conjugal transfer experiment was conducted to prove horizontal transmit of carbapenemase gene produced by E.cloacae.Meanwhile , the clinical epidemiological data of patients infected by selected strains were also analyzed.Results Sixty-four carbapenemase producing E.cloacae were detected by MHT, EDTA-disk synergy test and PCR amplification.Forty-five strains (70.3%) out of 64 strains infection came from nosocomial infection , while 19 strains (29.7%) from the community infection.The strains were mainly isolated from secretions samples and sputum samples , which accounted for 65.6% (42/64) and 23.4%(15/64) separately.The mainly clinical departments were orthopaedics (43.8%), department of burn (21.9%), ICU (18.8%) and pediatrics (14.1%).Bed changing, invasive operation and indwelling catheter were risk factors for the transmission of carbapenemase producing E.cloacae, and infected patients had longer time of staying in hospital , lower cure rate and higher frequency of cephalosporins enzyme inhibitor compound or carbapenem agents administration (all P<0.05).Sixty-four strains showed increased MIC to most of the antibiotics except for polymyxin and tigecycline.Among the 64 strains, 29 strains were genotype blaIMP-4 and 35 strains were genotype blaIMP-8 by Blast alignment , no genotype blaVIM , blaOXA-48 and blaNDM-1 were detected.Result of conjugal transfer experiment showed that receptor strain obtained carbapenem resistance , and the sequence of resistance gene of receptor strain was the same to the donator strain.Conclusions The drug resistance of E.cloacae are growing , IMP-4 and IMP-8 carbapenemase are the main enzymes produced by strains.As the resistance gene can horizontal transmit between strains through conjugal transfer system , the strains have been locally spread in hospital departments , thus it is important to control risk factors of transmission timely.
