携带blaNDM-1碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究

doi:10.3969/j.issn.1673-8640.2019.01.014

检验医学 ›› 2019, Vol. 34 ›› Issue (1): 67-70.DOI: 10.3969/j.issn.1673-8640.2019.01.014

携带bla_NDM-1碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究

李巍¹, 艾芙琪², 马逸珉², 王蓓², 田月如²()

1. 复旦大学附属儿科医院临床检验中心,上海 201102
2. 复旦大学附属华山医院检验科,上海 200040

收稿日期:2017-12-05 出版日期:2019-01-30 发布日期:2019-01-29
作者简介:null
作者简介：李巍,男,1991年生,学士,技师,主要从事临床耐药菌耐药机制的研究。
基金资助:
上海青年临床医技人才计划（沪医卫基[2016]04号）

Drug resistance mechanism of carbapenem resistant Providencia rettgeri carrying bla_NDM-1

LI Wei¹, AI Fuqi², MA Yimin², WANG Bei², TIAN Yueru²()

1. Department of Clinical Laboratory,Children's Hospital of Fudan University,Shanghai 201102,China
2. Department of Clinical Laboratory,Huashan Hospital,Fudan University,Shanghai 200040,China

Received:2017-12-05 Online:2019-01-30 Published:2019-01-29

摘要/Abstract

摘要：

目的研究碳青霉烯类耐药雷极普罗威登斯菌的耐药表型、耐药机制、传播方式及同源性。方法对分离自重症监护病房（ICU）的17株雷极普罗威登斯菌进行药物敏感性试验、耐药基因筛选、NP试验、脉冲场凝胶电泳（PFGE）、质粒可移动性及复制子分型分析。结果 17株雷极普罗威登斯菌均携带碳青霉烯类耐药基因bla_NDM-1。对厄他培南、美罗培南、亚胺培南、头孢唑林、头孢呋辛、头孢噻肟、头孢吡肟、头孢美唑、哌拉西林、甲氧苄啶-磺胺甲噁唑、阿米卡星、庆大霉素、妥布霉素、卡那霉素、环丙沙星、呋喃妥因的耐药率为100.00%,对哌拉西林-他唑巴坦、氨曲南的耐药率为88.23%。PFGE同源性分析显示17株雷极普罗威登斯菌中有15株为ICU主要流行株;质粒分析显示bla_NDM-1存在于~160 kb接合性质粒上,复制子Inc分型为A/C型,质粒携带多种耐药基因,除对环丙沙星和呋喃妥因敏感外,介导对碳青霉烯类、头孢类、头霉素类、磺胺类和氨基糖苷类抗菌药物高水平耐药。结论携带bla_NDM-1的雷极普罗威登斯菌多重耐药,临床抗感染治疗难度较大。

关键词: 雷极普罗威登斯菌, 碳青霉烯类耐药, bla_NDM-1基因, 耐药机制, 重症监护病房

Abstract:

Objective To investigate the phenotype,mechanism,disseminative way and homology of carbapenem resistant Providencia rettgeri. Methods A total of 17 isolates of Providencia rettgeri isolated from intensive care unit （ICU） were collected,and antibiotic susceptibility test,drug resistance gene detection,NP test,pulsed-field gel electrophoresis （PFGE）,plasmid mobility analysis and replicon typing were performed. Results The 17 isolates of carbapenem resistant Providencia rettgeri carried bla_NDM-1. The drug resistance rates to ertapenem,meropenem,imipenem,cefazolin,cefuroxime,cefotaxime,cefepime,cefmetazole,piperacillin,trimethoprim-sulfamethoxazole,amikacin,gentamicin,tobramycin,kanamycin,ciprofloxacin and furadantin were 100.00%. The drug resistance rates to piperacillin-tazobactam and aztreonam were 88.23%. PFGE homology analysis showed that 15 isolates were the main epidemic isolates in ICU. Plasmid analysis showed that the bla_NDM-1 were located on conjugative plasmid （-160 kb）,and replicon type was type A/C. Plasmid carried a variety of drug resistance genes,being sensitive to ciprofloxacin and furadantin,and it mediated the high-level drug resistance to carbapenems,cephalosporins,cephamycins,sulfonamides and aminoglycosides. Conclusions Providencia rettgeri carrying bla_NDM-1 shows multi-drug resistance to common antibiotics,and it brings challenge to clinical anti-infection treatment.

Key words: Providencia rettgeri, Carbapenem resistance, bla_NDM-1gene, Drug resistance mechanism, Intensive care unit

中图分类号:

R378.99

李巍, 艾芙琪, 马逸珉, 王蓓, 田月如. 携带bla_NDM-1碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究[J]. 检验医学, 2019, 34(1): 67-70.

LI Wei, AI Fuqi, MA Yimin, WANG Bei, TIAN Yueru. Drug resistance mechanism of carbapenem resistant Providencia rettgeri carrying bla_NDM-1[J]. Laboratory Medicine, 2019, 34(1): 67-70.

图/表 1

参考文献 17

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携带bla_NDM-1碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究

Drug resistance mechanism of carbapenem resistant Providencia rettgeri carrying bla_NDM-1

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携带blaNDM-1碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究

Drug resistance mechanism of carbapenem resistant Providencia rettgeri carrying blaNDM-1

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携带bla_NDM-1碳青霉烯类耐药雷极普罗威登斯菌耐药机制研究

Drug resistance mechanism of carbapenem resistant Providencia rettgeri carrying bla_NDM-1