临床常见革兰阴性菌对碳青霉烯类药物耐药性检测

目的完善我国西南地区临床常见革兰阴性细菌对碳青霉烯类药物耐药的分子流行病学资料。方法对2007年5月至2008年5月间从四川省4家医院采集的381株耐碳青霉烯类药物的临床菌株，进行4大类15种抗菌药物耐药性检测和产金属-β-内酰胺酶（MBLs）菌株筛选，并采用PCR对产MBLs菌株进行常见耐药基因的扩增。结果381株耐碳青霉烯类药物菌株中筛选到122株MBLs表型阳性的菌株，分别有45株产blaIMP（31株产blaIMP-9、8株产blaIMP-1、6株产blaIMP-4）、52株产blaVIM（48株产blaVIM-2，4株产blaVIM-1）、7株产blaNDM-1和16株菌株产blaSIM-1。此外，还有2株MBLs表型试验阳性菌株未鉴定出任何已知MBLs基因。结论381株受试菌株以多重耐药或全耐药菌株为主，我国西南地区耐碳青霉烯类药物临床菌株主要流行IMP型和VIM型MBLs，其中以产blaIMP-9和产blaVIM-2最为常见。

Detection of resistance to carbapenems in common clinical gram-negative bacteria

Objective To perfect the molecular epidemiology data of common clinically Gram-negative bacteria which are resistant to carbapenems in the Southwest China. Methods 381 isolates isolated from 4 hospitals of Sichuan Province from May 2007 to May 2008, were underwent susceptibility test of 15 antimicrobial agents in 4 major categories and detected for metallo-β-lactamase. The PCR was carried out on stains whose MBLs phenotypes were positive to identify 24 genotypes of drug-resistance associated genes. Results 122 isolates were confirmed producing metallo-13-1actamase （MBLs）, including 45 IMP （31 producing IMP-9, 8 producing IMP-1 and 6 producing IMP-4）, 52 VIM （48 producing VIM-2 and 4 producing VIM-l）, 7 NDM-1, 16 SIM-1 and 2 without any genotypes of MBLs to be identified. Conclusion Most of the 381 isolates were muhidrug resistant （MDR）, extensively drug-resistant （XDR） and pandrug-resistant （PDR）. IMP type and VIM type were the majorities of MBLs in the isolates which were resistant to carbapenems in southwest China.