| 耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分离株耐药性及耐药基因分析 |
| 投稿时间：2023-09-26 修订日期：2024-06-08 点此下载全文 |
| 引用本文：黄韵,张正银,金英,郑怡菁,李铁军,孙莉莉.耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分离株耐药性及耐药基因分析[J].药学实践杂志,2024,42(10):439~444 |
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| 基金项目:上海市浦东新区卫生系统学科建设项目-新兴、交叉学科（精准临床药学，PWXx2020-03） |
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| 中文摘要:目的 分析住院患者临床分离的耐碳青霉烯类肺炎克雷伯菌（CR-Kpn）及大肠埃希菌（CR-Eco）耐药现状、耐药类型并检测其相关耐药基因，为临床治疗耐碳青霉烯类肠杆菌目细菌（CRE）感染，合理使用抗菌药物提供参考。方法 收集上海交通大学附属仁济医院浦南分院2022年1月至12月患者临床标本分离的CR-Kpn、CR-Eco非重复分离株共400株，使用肉汤微量稀释法检测分离株对临床常用的抗菌药物的最低抑菌浓度，并通过耐药表型检测、聚合酶链反应（PCR）对 CRE的碳青霉烯酶及其相关耐药基因进行检测。结果 400株菌株中，检出CRE 51株(12.75%），CRE对替加环素、多黏菌素B的敏感率>95%。51株CRE中有49株产碳青霉烯酶，其中携带blaKPC 34株（66.67%）、携带blaNDM 13株（25.49%）、携带blaOXA-48 2株（3.92%）。结论 和其他临床常用抗菌药物相比，替加环素和多黏菌素B对产碳青霉烯酶的CR-Kpn及CR-Eco具有较好的体外抗菌活性。此外，耐药表型检测和基因型检测有较好的符合性，临床微生物实验室可持续跟踪检测CRE耐药表型和基因型，根据实际情况制订用药方案。 |
| 中文关键词:耐碳青霉烯类肠杆菌 碳青霉烯酶表型 碳青霉烯酶耐药基因 耐药性 |
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| Analysis of resistance situation and resistance genes of clinical isolates of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli |
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| Abstract:Objective To analyze the current status of anti-bacterial activity of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli clinically isolated from hospitalized patients, detect their related resistance genes, and provide reference for the clinical treatment of carbapenem resistant Enterobacteria （CRE） infections and the rational use of antibiotics. Methods A total of 400 non-repetitive isolates of Klebsiella pneumoniae and Escherichia coli isolated from clinical specimens of Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2022 to December were collected. The minimum inhibitory concentrations of these strains against commonly used antibiotics were determined by the broth microdilution method. The carbapenemase and related resistance genes of CRE were detected by drug resistance phenotype testing and PCR. Results Among the 400 strains, 51 strains were identified as CRE, accounting for 12.75%. Among these, 49 strains produced carbapenemases, with 41 strains （80.39%） being CR Klebsiella pneumoniae and 10 strains （19.61%） being CR Escherichia coli. Among the CRE strains, 34 strains （66.67%） carried blaKPC, 13 strains （25.49%） carried blaNDM, and 2 strains （3.92%） carried blaOXA-48. Conclusion Compared with other commonly used antibiotics, colistin and tigecycline exhibited good in vitro antibacterial activity against carbapenemase-producing Klebsiella pneumoniae and Escherichia coli. In addition, there was good concordance between drug resistance phenotype testing and genotyping. Clinical microbiology laboratories could continuously monitor the drug resistance phenotype and genotype of CRE and develop appropriate treatment plans based on actual conditions. |
| keywords:carbapenem-resistant enterobacteriaceae phenotype of carbapenemase carbapenemase resistance gene resistance |
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