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目的对本院2013年1月-2014年12月临床分离耐碳青霉烯酶肠杆菌科细菌进行blaNDM-1基因筛查,初探本院blaNDM-1基因携带阳性菌存在现状。方法采用MALDI-TOF质谱检测系统对所有菌株进行鉴定,用VITEK-2全自动微生物分析仪检测菌株的MIC值,筛选其中耐碳青霉烯酶肠杆菌科细菌,用改良Hodge试验进行表型确认,同时对试验菌株的blaNDM-1基因应用PCR方法进行筛检,其中阳性株外送进行PCR产物基因测序,测序结果进行BLAST比对。结果 14株耐碳青霉烯酶肠杆菌科细菌分别是8株肺炎克雷伯菌,6株大肠埃希菌。14株菌中有5株对替加环素敏感,9株对替加环素中介。仅从1株来自患者腹水标本中分离的肺炎克雷伯菌中检出blaNDM-1基因,基因序列同源性为99%。结论本次从肠杆菌科肺炎克雷伯菌中检出blaNDM-1基因,应为山西省首次报道,警示院感等相关部门应重视并加强对blaNDM-1基因携带菌的监测与筛查。
Objective To screen blaNDM-1 gene of Enterobacteriaceae resistant to carbapenemase from January 2013 to December 2014 in our hospital and to probe into the existing status of blaNDM-1 gene carrying positive bacteria in our hospital. Methods All strains were identified by MALDI-TOF mass spectrometry. The MIC values of strains were tested by VITEK-2 automatic microbiological analyzer. The Enterobacteriaceae strains resistant to carbapenema were screened and the phenotypes were confirmed by modified Hodge test Meanwhile, the blaNDM-1 gene of the test strain was screened by PCR method, in which the positive strains were sent for PCR gene sequencing and the sequencing results were BLAST aligned. Results The 14 strains of Enterobacteriaceae resistant to carbapenema were 8 strains of Klebsiella pneumoniae and 6 strains of Escherichia coli. Five of the 14 strains were sensitive to tigecycline and nine to tigecycline. The blaNDM-1 gene was detected in only one Klebsiella pneumoniae isolated from a patient’s ascites specimen, with 99% of the gene sequence homology. Conclusion The blaNDM-1 gene was detected in Enterobacteriaceae Klebsiella pneumoniae, which should be the first reported in Shanxi Province. It is necessary to pay attention to and strengthen the surveillance and screening of blaNDM-1 gene carrier bacteria.