本文選題：陰溝腸桿菌 + 耐藥分析　； 參考：《貴陽醫(yī)學院》2015年碩士論文

【摘要】：目的:1.了解我院2008年1月-2014年12月陰溝腸桿菌的臨床感染分布及對常用抗生素的耐藥情況,為臨床合理使用抗生素提供參考。2.明確我院陰溝腸桿菌產超廣譜β-內酰胺酶(ESBLs)和頭孢菌素酶(Amp C酶)及質粒介導耐藥基因的分布情況,初步探討我院陰溝腸桿菌的耐藥機制。3.了解我院陰溝腸桿菌耐藥株的分子流行病學特征,為進一步指導臨床有效控制耐藥菌株在醫(yī)院內的傳播提供依據。方法:1.采用WHONET 5.6軟件對7年間陰溝腸桿菌株的標本來源、感染科室、年齡分布及耐藥狀況進行回顧性統(tǒng)計分析;2.收集我院2013年6月-2014年6月臨床分離的非重復陰溝腸桿菌株共174株進行如下檢測:①采用多底物協(xié)同-拮抗法(MSSAT)對其進行ESBLs和Amp C酶的表型檢測;②PCR擴增質粒介導的ESBLs基因(TEM-1、SHV-12、CTX-M-3、SFO-1、VEB-3)、Amp C酶基因(ACT-1、DHA-1)和喹諾酮類耐藥(qnr)基因(qnr A、qnr B、qnr S);③應用腸桿菌科重復一致序列(ERIC)法對攜帶耐藥基因菌株進行分子流行病學研究,確定耐藥菌株間的親緣關系。結果:1.耐藥性分析結果顯示:7年間,陰溝腸桿菌對哌拉西林的耐藥率最高(44.0%~69.0%);對亞胺培南耐藥率最低(8.0%);2009-2013年,除了頭孢曲松、亞胺培南、復方新諾明、替卡西林/克拉維酸、哌拉西林/他唑巴坦外,陰溝腸桿菌對其余10種抗生素的耐藥率逐漸下降(P0.05);在各標本來源中,分泌物在陰溝腸桿菌中的絕對檢出率最高;7年間共分離出1596株陰溝腸桿菌,以呼吸道標本、分泌物、尿液標本為主,尿液中的陰溝腸桿菌對抗菌藥物的耐藥率最高;臨床感染科室主要集中在外科、內科、重癥監(jiān)護病房(ICU),ICU的耐藥率最高;從年齡組看,感染對象以成年和老年患者居多,老年人耐藥率最高,兒童組耐藥率最低。2.MSSAT結果顯示:174株陰溝腸桿菌中,單產Amp C酶92株(52.87%),單產ESBLs 1株(0.57%),產Amp C酶+ESBLs54株(31.03%),不產酶27株(15.52%);陰溝腸桿菌產酶株的耐藥率明顯高于不產酶株(P0.05),同時產Amp C酶+ESBLs菌株的耐藥率高于單產Amp C酶株的耐藥率(P0.05);產Amp C酶+ESBLs菌株對頭孢曲松,頭孢噻肟的耐藥率高達98.1%與96.3%,對青霉素類的哌拉西林高達92.5%,單環(huán)類的氨曲南耐藥率為88.9%,對阿米卡星耐藥率較低(15.1%),對亞胺培南敏感。3.PCR結果顯示:174株陰溝腸桿菌中,攜帶質粒介導的β-內酰胺酶基因71株,ESBLs基因檢出率為31.03%(54/174),43株TEM-1、22株SHV-12、21株CTX-M-3、12株SFO-1、1株VEB-3;Amp C酶基因檢出率為21.26%(37/174),22株DHA-1,17株ACT-1;71株β-內酰胺酶基因陽性菌中,僅含一種β-內酰胺酶基因的共30株,其余41株均為含兩種或兩種以上β-內酰胺酶基因。qnr耐藥基因檢出率為27.01%(47/174),qnr A 16株,qnr B 25株,qnr S 15株,其中,有9株陰溝腸桿菌同時檢測到兩種qnr基因;含ESBLs和(或)Amp C酶基因陽性菌株較耐藥基因陰性株更易同時攜帶qnr基因(P0.05)。4.ERIC法將70株攜帶耐藥基因的陰溝腸桿菌分為24型,主要的型別為X型(18株)、V型(9株)、W型(6株)。結論:1.陰溝腸桿菌對臨床常用抗菌藥物的耐藥率呈下降趨勢,對于碳青霉烯類抗生素不敏感菌株的出現應引起重視;碳青霉烯類抗菌藥物依然是治療多重耐藥陰溝腸桿菌感染的首選。2.本院陰溝腸桿菌以產Amp C酶為主,同時產Amp C酶和ESBLs的菌株對第三代頭孢菌素、單環(huán)類、青霉素類具有高度耐藥性。3.陰溝腸桿菌同時存在不同類型的β-內酰胺酶基因和qnr基因,ESBLs耐藥基因以TEM-1型為主;ESBLs和(或)Amp C酶基因陽性株可同時攜帶qnr基因。4.陰溝腸桿菌在醫(yī)院內存在部分克隆株散在傳播情況。
[Abstract]:Objective: 1. to understand the distribution of the clinical infection of Enterobacter cloacae in our hospital in December -2014 January 2008 and the resistance to common antibiotics in order to provide a reference.2. for the rational use of antibiotics in the clinic to clarify the distribution of the broad-spectrum beta lactamase (ESBLs) and cephalosporins (Amp C enzyme) and plasmid mediated resistance genes in our hospital. Study on the resistance mechanism of Enterobacter cloacae in our hospital.3. to understand the molecular epidemiological characteristics of antibiotic resistant strains of Enterobacter cloacae in our hospital in order to further guide the effective control of the spread of drug resistant strains in hospitals. Methods: 1. WHONET 5.6 software was used for the specimen origin, infection section, age distribution and distribution of Enterobacter cloacae in 7 years. A retrospective statistical analysis of the drug resistance status was carried out; 2. a total of 174 non repetitive strains of Enterobacter cloacae isolated from our hospital in June -2014 June 2013 were detected as follows: (1) the phenotypic detection of ESBLs and Amp C enzyme was carried out by multi substrate synergistic antagonistic method (MSSAT); and (2) PCR amplified plasmid mediated ESBLs gene (TEM-1, SHV-12, CTX-M-3, SFO-1, V) EB-3), the Amp C enzyme gene (ACT-1, DHA-1) and quinolone resistance (qnr) gene (qnr A, qnr B, qnr S); (3) the molecular epidemiological study of the strains carrying resistance genes was carried out by the repeated sequence of Enterobacteriaceae. Results: 1. the results of drug resistance analysis showed that 7 years, Enterobacter cloacae to piperaca. The drug resistance rate of Cilin was the highest (44.0%~69.0%), and the resistance rate to imipenem was lowest (8%); in 2009-2013 years, the resistance rate of Enterobacter cloacae to the remaining 10 antibiotics was gradually decreased (P0.05) except ceftriaxone, imipenem, compound sulfamethamine, cicillin / clavulanic acid, piperacillin / tazobactam (piperacillin / tazobactam); and secretions in the specimens were in the Yin. The absolute detection rate of Enterobacter cloacae was the highest; 1596 strains of Enterobacter cloacae were isolated in 7 years, with respiratory specimens, secretions and urine specimens, and the resistance rate of Enterobacter cloacae in urine was the highest. The clinical infection departments were mainly concentrated in surgery, internal medicine and ICU, and the rate of ICU was the highest; from the age group, the rate of drug resistance was the highest. The majority of adult and elderly patients were infected, and the drug resistance rate of the elderly was the highest, and the lowest.2.MSSAT results in the children group showed that among 174 strains of Enterobacter cloacae, there were 92 strains of Amp C, 1 (0.57%), Amp C +ESBLs54 strain (31.03%) and 27 (15.52%), and the resistance rate of Enterobacter cloacae was significantly higher than that of non production. The resistance rate of Amp C enzyme +ESBLs strain was higher than that of Amp C strain (P0.05), and the resistance rate of Amp C enzyme +ESBLs strain to ceftriaxone and cefotaxime was 98.1% and 96.3%, the penicillin piperacillin was up to 92.5%, the monosacylic amamoxan resistance rate was 88.9%, and the resistance rate of Amikacin was lower (15.1%). The results of imipenem sensitive.3.PCR showed that in 174 strains of Enterobacter cloacae, 71 strains of plasmid mediated beta lactamase gene were carried, the detection rate of ESBLs gene was 31.03% (54/174), 43 strains of TEM-1,22 strain SHV-12,21 strain SFO-1,1 strain VEB-3, Amp C enzyme gene detection rate of 21.26% (37/174), 22 strains of DHA-1,17 strains, and 71 beta lactamase genes. Among the positive bacteria, only a total of 30 strains of beta lactamase genes were contained, and the other 41 were 27.01% (47/174), qnr A 16, qnr B 25, and qnr S 15, including two or more than two beta lactamase genes, of which 9 strains of Enterobacter cloacae were detected at the same time, two qnr genes were detected, and ESBLs and / or Amp C enzyme gene positive bacteria were detected. Qnr gene (P0.05).4.ERIC method was more easy to carry 70 strains of Enterobacter cloacae carrying resistance genes into type 24, the main types were X type (18 strains), V type (9 strains), and W type (6 strains). Conclusion: 1. the resistance rate of Enterobacter cloacae to clinical antibiotics is decreasing and insensitive to carbapenems. The emergence of strains should be paid attention to; carbapenems are still the first choice for the treatment of multiple resistant Enterobacter cloacae infection in.2. our hospital, Amp C enzyme producing Enterobacter cloacae, and Amp C and ESBLs producing strains of third generation cephalosporins, mono rings, penicillins, highly resistant.3. Enterobacter cloacae at the same time Type of beta lactamase gene and qnr gene, ESBLs resistant gene is dominated by TEM-1 type, and ESBLs and (or) Amp C gene positive strain can carry the qnr gene.4. clones at the same time in the hospital memory in the spread of some clones.
【學位授予單位】：貴陽醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R446.5

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