耐碳青霉烯类肠杆菌科细菌对喹诺酮类耐药机制的研究
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摘要
目的研究质粒介导喹诺酮耐药(PMQR)基因在耐碳青霉烯类肠杆菌(CRE)中的流行情况及耐药机制。方法收集2015年3月—2018年3月某院临床分离的CRE菌株,VITEK2 Compact分析仪对其进行鉴定及药物敏感试验,采用聚合酶链反应(PCR)及测序确定PMQR基因qnrA、qnrB、qnrS、qepA、acc(6’)Ib-cr携带情况,通过质粒接合试验验证PMQR基因的水平转移。结果耐碳青霉烯类大肠埃希菌对喹诺酮类药物的耐药率达100%,耐碳青霉烯类肺炎克雷伯菌对喹诺酮类药物的耐药率为15.56%～33.33%。acc(6’)Ib-cr基因检出率最高(87.72%),其次为qnrB(77.19%)和qnrS(17.54%),有2株菌携带qnrA基因(3.51%),未分离出qepA基因,菌株同时含有2种或3种PMQR基因(84.21%)。8株接合成功的菌株均存在PMQR基因转入,但喹诺酮药物对其最低抑菌浓度无明显改变。结论虽然该院CRE质粒介导喹诺酮耐药基因检出率高,但对喹诺酮类药物仍存在一定敏感性。
Objective To study the prevalence of plasmid-mediated quinolone resistance(PMQR)genes in carbapenem-resistant Enterobacteriaceae(CRE)and its resistance mechanism.Methods Clinically isolated CRE strains in a hospital from March 2015 to March 2018 were collected,then identified and performed antimicrobial susceptibility test by VITEK2 Compact analyzer,carriage of PMQR genes qnrA,qnrB,qnrS,qepA and acc(6')Ib-cr were determined by polymerase chain reaction(PCR)and sequencing,the horizontal transfer of PMQR genes were verified by plasmid conjugation test.Results Resistance rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae to quinolones were 100% and 15.56%-33.33% respectively.Detection rate of acc(6')Ib-cr gene was the highest(87.72%),followed by qnrB(77.19%)and qnrS(17.54%),2 strains(3.51%)carried qnrA gene,qepA gene was not isolated,84.21% of strains harbored 2 or 3 PMQR genes.PMQR gene was transfected into all the 8 conjugated strains,but minimum inhibitory concentration value of quinolones didn't change significantly.Conclusion The detection rate of PMQR genes in CRE in this hospital is high,but there is a certain sensitivity to quinolones.
Objective To study the prevalence of plasmid-mediated quinolone resistance(PMQR)genes in carbapenem-resistant Enterobacteriaceae(CRE)and its resistance mechanism.Methods Clinically isolated CRE strains in a hospital from March 2015 to March 2018 were collected,then identified and performed antimicrobial susceptibility test by VITEK2 Compact analyzer,carriage of PMQR genes qnrA,qnrB,qnrS,qepA and acc(6')Ib-cr were determined by polymerase chain reaction(PCR)and sequencing,the horizontal transfer of PMQR genes were verified by plasmid conjugation test.Results Resistance rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae to quinolones were 100% and 15.56%-33.33% respectively.Detection rate of acc(6')Ib-cr gene was the highest(87.72%),followed by qnrB(77.19%)and qnrS(17.54%),2 strains(3.51%)carried qnrA gene,qepA gene was not isolated,84.21% of strains harbored 2 or 3 PMQR genes.PMQR gene was transfected into all the 8 conjugated strains,but minimum inhibitory concentration value of quinolones didn't change significantly.Conclusion The detection rate of PMQR genes in CRE in this hospital is high,but there is a certain sensitivity to quinolones.
引文
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[6]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[7]Yang HY,Nam YS,Lee HJ.Prevalence of plasmid-mediated quinolone resistance genes among ciprofloxacin-nonsusceptible Escherichia coli and Klebsiella pneumoniae isolated from blood cultures in Korea[J].Can J Infect Dis Med Microbiol,2014,25(3):163-169.
[8]龙永艳,吴葵,傅松哲,等.质粒介导的喹诺酮耐药细菌的耐药机制[J].热带医学杂志,2018,18(1):122-126,138.
[9]黄支密,夏守慧,沈娟,等.携带bla_(KPC-2)型碳青霉烯酶基因泛耐药肺炎克雷伯菌对喹诺酮类耐药机制研究[J].中华医院感染学杂志,2015,25(8):1684-1686.
[10]阮荣华,段达荣,叶雅丽,等.门诊患者尿液分离大肠埃希菌喹诺酮类耐药机制研究[J].中国卫生检验杂志,2017,27(22):3319-3320.
[11]Wu JJ,Ko WC,Tsai SH,et al.Prevalence of plasmid-mediated quinolone resistance determinants QnrA,QnrB,and QnrSamong clinical isolates of Enterobacter cloacae in a Taiwanese hospital[J].Antimicrob Agents Chemother,2007,51(4):1223-1227.
[12]Kim HB,Park CH,Kim CJ,et al.Prevalence of plasmid-mediated quinolone resistance determinants over a 9-year period[J].Antimicrob Agents Chemother,2009,53(2):639-645.
[13]兰芳俊,吴娟,何清雯,等.临床分离大肠埃希菌质粒介导喹诺酮耐药基因和β内酰胺酶基因检测[J].中国感染与化疗杂志,2017,17(3):293-297.
[14]何礼贤.喹诺酮类抗菌药物的耐药现状、恰当评价和合理使用[J].国外医药(抗生素分册),2015,36(6):249-255.
[15]García-Fulgueiras V,Bado I,Mota MI,et al.Extended-spectrumβ-lactamases and plasmid-mediated quinolone resistance in enterobacterial clinical isolates in the paediatric hospital of Uruguay[J].J Antimicrob Chemother,2011,66(8):1725-1729.
[16]毛小琴,苑荣亮.医院肠杆菌科细菌质粒介导喹诺酮耐药机制研究[J].中国病原生物学杂志,2017,12(12):1140-1143,1147.
[2]Peymani A,Farivar TN,Najafipour R,et al.High prevalence of plasmid-mediated quinolone resistance determinants in Enterobacter cloacae isolated from hospitals of the Qazvin,Alborz,and Tehran provinces,Iran[J].Rev Soc Bras Med Trop,2016,49(3):286-291.
[3]吕月蒙.耐碳青霉烯类肠杆菌科细菌的分子特征、耐药机制及药物发现[D].北京:北京协和医学院,2015.
[4]宫雪,王勇,张吉生,等.耐碳青霉烯肺炎克雷伯菌耐药机制及同源性分析[J].临床检验杂志,2018,36(4):270-273.
[5]付启云,郑绍同.常见医院感染病原菌对喹诺酮类药物的耐药性[J].中国感染控制杂志,2013,12(6):457-460.
[6]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[7]Yang HY,Nam YS,Lee HJ.Prevalence of plasmid-mediated quinolone resistance genes among ciprofloxacin-nonsusceptible Escherichia coli and Klebsiella pneumoniae isolated from blood cultures in Korea[J].Can J Infect Dis Med Microbiol,2014,25(3):163-169.
[8]龙永艳,吴葵,傅松哲,等.质粒介导的喹诺酮耐药细菌的耐药机制[J].热带医学杂志,2018,18(1):122-126,138.
[9]黄支密,夏守慧,沈娟,等.携带bla_(KPC-2)型碳青霉烯酶基因泛耐药肺炎克雷伯菌对喹诺酮类耐药机制研究[J].中华医院感染学杂志,2015,25(8):1684-1686.
[10]阮荣华,段达荣,叶雅丽,等.门诊患者尿液分离大肠埃希菌喹诺酮类耐药机制研究[J].中国卫生检验杂志,2017,27(22):3319-3320.
[11]Wu JJ,Ko WC,Tsai SH,et al.Prevalence of plasmid-mediated quinolone resistance determinants QnrA,QnrB,and QnrSamong clinical isolates of Enterobacter cloacae in a Taiwanese hospital[J].Antimicrob Agents Chemother,2007,51(4):1223-1227.
[12]Kim HB,Park CH,Kim CJ,et al.Prevalence of plasmid-mediated quinolone resistance determinants over a 9-year period[J].Antimicrob Agents Chemother,2009,53(2):639-645.
[13]兰芳俊,吴娟,何清雯,等.临床分离大肠埃希菌质粒介导喹诺酮耐药基因和β内酰胺酶基因检测[J].中国感染与化疗杂志,2017,17(3):293-297.
[14]何礼贤.喹诺酮类抗菌药物的耐药现状、恰当评价和合理使用[J].国外医药(抗生素分册),2015,36(6):249-255.
[15]García-Fulgueiras V,Bado I,Mota MI,et al.Extended-spectrumβ-lactamases and plasmid-mediated quinolone resistance in enterobacterial clinical isolates in the paediatric hospital of Uruguay[J].J Antimicrob Chemother,2011,66(8):1725-1729.
[16]毛小琴,苑荣亮.医院肠杆菌科细菌质粒介导喹诺酮耐药机制研究[J].中国病原生物学杂志,2017,12(12):1140-1143,1147.
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