【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。更多还原

【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 antiinfection treatment.更多还原