河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (10): 1203-1207.doi: 10.3969/j.issn.1007-3205.2022.10.018

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基于PCR快速检测分析某院ICU患者中CRE菌株耐药特点

  

  1. 江苏省海安市中医院检验科，江苏 海安 226600

  • 出版日期:2022-10-25 发布日期:2022-11-16
  • 作者简介:花鸿燕（1988-），女，江苏南通人，江苏省海安市中医院主管技师，医学学士，从事医学检验学方向研究。
  • 基金资助:
    南通市市级科技计划（指导性）项目（JCZ19017）

Analysis of the characteristics of drug resistance of CRE strain in ICU patients of a hospital based on rapid detection using PCR

  1. Department of Laboratory, Hai′an Hospital of Traditional Chinese Medicine, Jiangsu Province，Haian 226600，China

  • Online:2022-10-25 Published:2022-11-16

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摘要： 目的 探讨某院重症监护室（intensive care unit，ICU）患者体内抗碳青霉烯类（carbapenem-resistant enterobacter，CRE）杆菌分布情况、耐药机制，并使用聚合酶链反应（polymerase chain reaction，PCR）快速检测分析其Ⅰ型新德里金属β-内酰胺酶（New Delhi metallo-β-lactamase 1,NDM-1）基因的表达特点。
方法  回顾性分析江苏省海安市中医院收治的ICU患者150例。采用全自动微生物分析仪分析ICU患者CRE检出情况，统计主要CRE的检出率及在各标本中的检出情况；统计主要CRE菌株对临床中常用的抗菌药物的耐药性情况；采用PCR快速检测分析NDM-1基因的表达特点。
结果 在150例ICU患者中共分离出肠杆菌科细菌643株，其中CRE菌株为165株（25.66%），且在痰液中存在肠杆菌及CRE菌种占比最高，分别为41.06%及44.85%，在分离出的165株CRE菌株中，主要以黏质沙雷菌（26.06%）为主，其次为肺炎克雷伯菌（23.64%）及阴沟肠杆菌（20.00%）；药敏结果显示在165株CRE菌株中，其中敏感程度最高的为替加环素（100%），其次为环丙沙星（80.00%）及阿米卡星（74.55%）；在165株CRE菌株中产DNM-1基因的菌株数量最多，占58.79%，其次为KPC基因与VIM基因，分别为23.03%及18.18%。
结论 某院ICU患者CRE菌种主要为黏质沙雷菌、肺炎克雷伯菌及阴沟肠杆菌，且对临床中常用的β-内酰胺类抗菌药物耐药性较高，其中含有的基因型大部分为NDM-1，进一步限制临床治疗进度。


关键词: 耐碳青霉烯类肠杆菌科, 聚合酶链反应测定, ICU患者

Abstract: Objective To investigate the distribution and drug resistance mechanism of carbapenem-resistantenterobacter(CRE) bacilli in intensive care unit(ICU) patients of a hospital, and to analyze the expression characteristics of New Delhi metallo-β-lactamase 1(NDM-1) gene after rapid detection using polymerase chain reaction(PCR). 
Methods A retrospective analysis was made on 150 ICU patients admitted to Hai′an Hospital of Traditional Chinese Medicine in Jiangsu Province. Automatic microbiological analyzer was used to analyze the detection of CRE in ICU patients. The detection rate of main CRE and the detection situation in each specimen were calculated. The resistance of main CRE strains to antibiotics commonly used in clinical practice was analyzed. The expression characteristics of NDM-1 gene were analyzed by PCR. 
Results A total of 643 strains of enterobacteriaceae were isolated from 150 ICU patients, of which 165 were CRE strains(25.66%). The proportion of Enterobacteriaceae and CRE strains in sputum was the highest(41.06% and 44.85%, respectively). Among 165 strains of CRE isolated, Serratia marcescens was the main strain(26.06%), followed by Klebsiella pneumoniae(23.64%) and Enterobacter cloacis(20.00%). Drug sensitivity results showed that, among 165 CRE strains, tigecycline was the most sensitive(100%), followed by ciprofloxacin(80.00%) and amikacin(74.55%). Among 165 CRE strains, DNM-1 gene was the most abundant, accounting for 58.79%, followed by KPC and VIM, accounting for 23.03% and 18.18%, respectively. 
Conclusion The main strains of CRE in ICU patients in a hospital are Serratia marcescens, Klebsiella pneumoniae and enterobacter cloacei, and they have high resistance to β -lactam antibiotics commonly used in clinical practice, most of which contain NDM-1, further limiting the progress of clinical treatment.


Key words: carbapenem-resistant enterobacteriaceae, polymerase chain reaction, assay, ICU patients

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