| 临床来源碳青霉烯耐药大肠埃希菌药物敏感性及分子流行病学特征分析 |
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| 引用本文： | 贾园春,袁敏,陈东科,周海健,陈霞,赵晓菲,李娟,陈会波. 临床来源碳青霉烯耐药大肠埃希菌药物敏感性及分子流行病学特征分析[J]. 疾病监测, 2017, 32(4): 346-350. DOI: 10.3784/j.issn.1003-9961.2017.04.021 |
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| 作者姓名： | 贾园春 袁敏 陈东科 周海健 陈霞 赵晓菲 李娟 陈会波 |
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| 作者单位： | 1.潍坊医学院公共卫生与管理学院, 山东 潍坊 261053 |
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| 基金项目： | 国家自然科学基金(No.81501783)This study was supported by the fund from National Natural Science Foundation of China |
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| 摘 要： | 目的 探讨临床分离的碳青霉烯耐药大肠埃希菌药物敏感性特征及分子流行病学特征，为院内感染控制及临床治疗提供基础数据。方法 收集某医院临床分离的21株对碳青霉烯类药物耐药的大肠埃希菌，采用琼脂稀释法测定菌株对11种临床常用药物的最低抑菌浓度（MIC）；Carba NP试验检测菌株产碳青霉烯酶情况；采用PCR扩增及序列比对检测耐药基因（包括blaNDM、blaKPC、blaIMP、blaVIM、blaOXA）携带状况；采用脉冲场凝胶电泳（PFGE）和多位点序列分型（MLST）对菌株进行分子分型。结果 21株碳青霉烯耐药大肠埃希菌中，对哌拉西林、头孢吡肟、头孢曲松、头孢他啶等-内酰胺类药物和左氧氟沙星耐药率为100.00%；对甲氧苄啶-磺胺甲恶唑的耐药率也高达76.19%；对米诺环素、阿米卡星和磷霉素的耐药率相对较低，分别为23.81%、23.81%和19.05%。Carba NP试验阳性菌株17株，均携带blaNDM-1基因，其余4种基因检测均为阴性。MLST显示21株菌株共有9种ST型别，其中携带blaNDM-1基因的大肠埃希菌主要为ST167型和ST540型。PFGE显示来自泌尿外科的3株菌株电泳图谱完全相同，另外来自不同病房的2株菌株电泳图谱也完全相同，提示医院内存在同一克隆菌株传播的可能。结论 该医院碳青霉烯耐药大肠埃希菌基因型分布呈现多态性；对碳青霉烯类药物耐药的机制主要是携带blaNDM-1基因；携带该基因的大肠埃希菌对临床常用抗菌药物往往呈现多重耐药，给临床治疗带来了困难。加强对碳青霉烯耐药菌株基因型和耐药基因的检测，将对减缓或阻断耐药菌的传播具有重要意义。
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| 关 键 词： | 碳青霉烯耐药 大肠埃希菌 碳青霉烯酶 脉冲场凝胶电泳 多位点序列分型 |
| 收稿时间： | 2016-11-02 |
Drug susceptibility and molecular epidemiological characteristics of clinical isolates of carbapenem-resistant Escherichia coli |
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| JIA Yuan-chun,YUAN Min,CHEN Dong-ke,ZHOU Hai-jian,CHEN Xia,ZHAO Xiao-fei,LI Juan,CHEN Hui-bo. Drug susceptibility and molecular epidemiological characteristics of clinical isolates of carbapenem-resistant Escherichia coli[J]. Disease Surveillance, 2017, 32(4): 346-350. DOI: 10.3784/j.issn.1003-9961.2017.04.021 |
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| Authors: | JIA Yuan-chun YUAN Min CHEN Dong-ke ZHOU Hai-jian CHEN Xia ZHAO Xiao-fei LI Juan CHEN Hui-bo |
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| Affiliation: | 1.School of Public Health and Management, Weifang Medical University, Weifang 261053, Shandong, China2.State Key Laboratory for Communicable Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China3.Department of Clinical Laboratory, Beijing Hospital, Beijing 100730, China |
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| Abstract: | Objective To explore the drug susceptibility and molecular epidemiological characteristics of clinical isolates of carbapenem-resistant Escherichia coli.Methods A total of 21 carbapenem-resistant E.coli strains were isolated from a hospital in 2015.The minimum inhibitory concentration (MIC) of these strains were detected by agar dilution method.Carba NP test was used to detect carbapenemases.Carbapenemase genes including blaNDM,blanc,blaIMP,blaVIM and blaoxA were detected by PCR followed by sequence alignment;Pulsed-field gel electrophoresis (PFGE) and multi locus sequence typing (MLST) were performed for the molecular subtyping.Results All the 21 carbapenem-resistant E.coli strains were resistant to imipenem,meropenem,piperacillin,cefepime,ceftriaxone,ceftazidime and levofloxacin.The resistant rate to trimethoprim sulfamethoxazole was as high as 76.19％.The resistant rates to minocycline,amikacin and fosfomycin were 23.81％,23.81％and 19.05％,respectively.Seventeen strains were positive in Carba NP test.PCR and sequences alignment confirmed that the 17 strains carried blaNDM-1 genes.The other four carbapenemase genes were not detected.MLST analysis showed that 21 strains could be divided into nine ST types,ST167 and ST540 were detected in the strains carrying blaNDM.1.Three strains from a urology ward had identical PFGE patterns and another two strains from different wards also had identical patterns,suggesting the spread of an E.coli clone in the ward.Conclusion blaNDM-1 gene was carried by E.coli strains with different ST types in the hospital.E.coli strains carrying the blaNDM-1 were highly resistant to common antimicrobial drugs.It is important to strengthen the detection and surveillance of transmission of E.coli strains carrying blaNDM-1 gene in hospitals. |
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| Keywords: | Carbapenem-resistant Escherichia coli Carbapenemases Pulsed-field gel electrophoresis Multi locus sequence typing |
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