阴沟肠杆菌产β-内酰胺酶和质粒介导耐药基因的检测及耐药性分析

【摘要】 目的 明确阴沟肠杆菌产超广谱β-内酰胺酶(ESBLs)、头孢菌素酶(AmpC酶)和qnr耐药基因的分布情况,初步探讨阴沟肠杆菌的耐药机制。方法 收集2016年1月至2017年6月临床分离的非重复阴沟肠杆菌共89株,采用多底物协同-拮抗法(MSSAT)检测ESBLs和AmpC酶的表型,采用PCR扩增质粒介导的ESBLs基因(TEM-1、SHV-12、CTX-M、SFO-1、VEB-3)、AmpC酶基因(ACT-1、DHA-1)和喹诺酮类耐药(qnr)基因(qnrA、qnrB、qnrS)。结果 MSSAT结果 显示,89株阴沟肠杆菌中,单产ESBLs 13株(14.61%),单产AmpC酶41株(46.07%),同时产ESBLs和AmpC酶24株(26.97%)。PCR结果 显示:ESBLs基因检出率为38.20%, AmpC酶基因检出率为19.10%, qnr基因检出率为12.36%。结论 本院阴沟肠杆菌以产AmpC酶为主,碳青霉烯类抗菌药物依然是治疗多重耐药阴沟肠杆菌感染的首选。质粒介导的ESBLs、AmpC、qnr基因,临床分布较广泛,临床应合理使用抗菌药物,加强对阴沟肠杆菌的耐药性监测。更多还原

【Abstract】 Objective To clarify the distribution of ESBLs, AmpC and qnr resistance genes in our hospital, and explore the mechanism of resistance of Enterobacter cloacae in our hospital. Methods A total of 89 non-repetitive Enterobacter cloacae were isolated from January 2016 to June 2017. The phenotypic detection of ESBLs and AmpC were carried out by multi-substrate synergistic-antagonism( MSSAT). The plasmidmediated ESBLs gene(TEM-1, SHV-12, CTX-M, SFO-1, VEB-3), AmpC enzyme gene(ACT-1, DHA-1) and quinolones resistant(qnr) gene( qnrA, qnrB, qnrS) were amplified by PCR. Results MSSAT results showed that there were 13 strains( 14.61%) of ESBLs, 41 strains(46.07%) of AmpC enzyme and 24 strains of ESBLs and AmpC( 26.97%) in 89 strains of Enterobacter cloacae. The results of PCR showed the detection rate of ESBLs gene was 38.20%, the detection rate of AmpC enzyme gene was 19.10% and the detection rate of qnr gene was 12.36%.Conclusion Enterobacter cloacae mainly produces AmpC enzyme, carbapenem antibiotics is still the main choice for the treatment of multi—drug resistant Enterobacter cloacae infection. Plasmid mediated ESBLs, AmpC and qnr genes are widely distributed in clinic, antibiotics should be reasonable used in the Clinical treatment. Resistance monitoring of Enterobacter cloacae needs to be strengthened.更多还原