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目的分析2011-2015年临床分离的肠杆菌科细菌耐药性变迁及主要碳青霉烯酶基因型。方法以美国临床和实验室标准协会(CLSI)2015版为判定标准进行抗菌药物敏感性分析,筛选出亚胺培南或美罗培南耐药的肠杆菌科细菌(CRE)共39株,用PCR方法扩增常见碳青霉烯酶基因(bla_(KPC)、bla_(IMP)、bla_(VIM)、bla_(NDM)),并对PCR扩增产物进行测序比对分析。结果共收集4542株肠杆菌科细菌,位列前3位的分别是大肠埃希菌(44.8%)、肺炎克雷伯菌(24.8%)和阴沟肠杆菌(4.8%)。肠杆菌科细菌对碳青霉烯类耐药率最低(<7%),其次是阿米卡星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦菌(<20%)。产超广谱β内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为57.8%,38.3%。39株CRE以肺炎克雷伯菌(12/39)、阴沟肠杆菌(8/39)为主,有13株扩增出碳青霉烯酶基因,其中10株携带有bla_(KPC-2)基因,以肺炎克雷伯菌(5/10)为主;3株携带有bla_(IMP-4)基因。结论 5年间肠杆菌科细菌耐药率变化趋势不明显,CRE菌株有增加趋势,基因型以bla_(KPC-2)为主。
Objective To analyze the changes of bacterial resistance and the major carbapenemase genotypes in clinically isolated Enterobacteriaceae from 2011 to 2015. Methods According to the CLSI 2015 version, 39 strains of Enterobacteriaceae (CRE) resistant to imipenem or Meropenem were screened for their antibacterial susceptibility. PCR was performed Common PCR products were amplified and sequenced. The common PCR products were amplified by PCR, and sequenced. Results A total of 4542 strains of Enterobacteriaceae were collected. The top three strains were Escherichia coli (44.8%), Klebsiella pneumoniae (24.8%) and Enterobacter cloacae (4.8%). Enterobacteriaceae had the lowest rates of carbapenem resistance (<7%), followed by amikacin, piperacillin / tazobactam and cefoperazone / sulbactam (<20%). The detection rates of Escherichia coli and Klebsiella pneumoniae producing ESBLs were 57.8% and 38.3% respectively. Among the 39 CRE strains, Klebsiella pneumoniae (12/39) and Enterobacter cloacae (8/39) were the major pathogens, of which 13 strains amplified carbapenemase genes, of which 10 strains carried bla_ (KPC-2) The gene was mainly Klebsiella pneumoniae (5/10). The three strains carried bla_ (IMP-4) gene. Conclusion The trend of change of drug resistance rate of Enterobacteriaceae in 5 years is not obvious, and the CRE strain has an increasing trend. The genotype of blakes is KPC-2.