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目的研究大连医科大学附属一院2013-2014年期间收集的68株对碳青霉烯类药物耐药肠杆菌科细菌(CRE)的药敏结果、耐药基因携带情况及传播机制。方法采用WHONET 5.6软件分析菌株耐药情况;聚合酶链反应技术(PCR)检测KPC、IMP、VIM、ISCR1及ISCR1可变区;ERIC-PCR进行同源性分析。结果 2014年与2013年相比较,各类抗生素的耐药率差异虽没有统计学意义,但均有所升高,升高率大部分约为20%;68株CRE中,KPC阳性16株,占23.5%,IMP阳性2株,占2.9%,VIM阳性17株,占25.0%,ISCR1阳性37株,占54.4%,ISCR1可变区阳性21株,占30.9%;ERIC-PCR将45株碳青霉烯类耐药肺炎克雷菌分为4个型别(A~D):A型占64.5%,B型占13.3%,C型占8.9%,D型占13.3%;23株碳青霉烯类耐药大肠埃希菌分为3个型别(A~C):A型占60.9%,B型占30.4%,C型占8.7%。结论 ISCR1是耐药基因分子间水平传播的重要原因。
Objective To investigate the drug susceptibility, resistance gene carriage and transmission mechanisms of 68 strains of carbapenem-resistant Enterobacteriaceae (CRE) collected in the first affiliated hospital of Dalian Medical University during 2013-2014. Methods The drug resistance of strains was analyzed by WHONET 5.6 software. The variable regions of KPC, IMP, VIM, ISCR1 and ISCR1 were detected by polymerase chain reaction (PCR) and the homology was analyzed by ERIC-PCR. Results Compared with 2013, the antibiotic resistance rates of all kinds of antibiotics did not show statistical significance in 2014, but all of them increased at a rate of about 20%. Among 68 CRE strains, 16 were KPC positive, Accounting for 23.5%, IMP positive 2, accounting for 2.9%, VIM positive 17, accounting for 25.0%, ISCR1 positive 37, accounting for 54.4%, ISCR1 variable 21 positive, accounting for 30.9%; ERIC- Pelargine-resistant Klebsiella pneumoniae was divided into four types (A ~ D): A type accounted for 64.5%, B type accounted for 13.3%, C type accounted for 8.9%, D type accounted for 13.3%; 23 carbon blue Mycobacterial resistant Escherichia coli was divided into three types (A ~ C): A type accounted for 60.9%, B type accounted for 30.4%, C type accounted for 8.7%. Conclusion ISCR1 is an important reason for the horizontal transmission of drug-resistant genes.