摘要
目的研究聊城地区新德里金属β-内酰胺酶(NDM)菌株的分子流行病学及感染危险因素。方法采用分层抽样法从聊城地区2014年1月至2018年12月15所医院中抽取样本5689例,其中,临床标本中分离的碳青霉烯类耐药肠杆菌科细菌共112份,回顾性研究分析院内感染危险因素。用改良Hodge试验、ETP-EDTA协同试验、mCIM试验确证表型。用PCR法扩增碳青霉烯酶基因。结果5689例样本中临床标本中分离的碳青霉烯类耐药肠杆菌科细菌共112份,发生率1.97%。可见,不同危重度、合并基础疾病、存在侵入性操作、使用糖皮质激素、使用免疫抑制剂药物是碳青霉烯类耐药情况下碳青霉烯类耐药肠杆菌科细菌感染率差异有统计学意义(P<0.05)。Logistic回归分析模型结果显示,危重度(符合并入住ICU)、合并基础疾病(2种及以上)、存在侵入性操作、使用糖皮质激素、使用免疫抑制剂药物是碳青霉烯类耐药肠杆菌科细菌感染的独立危险因素(OR=1.977、1.558、1.103、1.078、1.770,P<0.05),26株产NDM肠杆菌科细菌呈现多重耐药性,其中7株对亚胺培南耐药、8株对厄他培南耐药、6株对美罗培南耐药,5株对3种药物都敏感。PCR结果显示,26株产NDM的大肠埃希菌分为4个基因型,其中9株D型,8株B型,5株C型,4株A型。结论医院已出现多种NDM亚型,主要感染因素为侵袭性操作及抗生素的应用,主要通过X3型质粒在肠杆菌科细菌中传播。
Objective To study the molecular epidemiology and infection risk factors of bacterial strain with New Delhi metallo-β-lactamases(NDM)in Liaocheng area.Methods A stratified sampling method was used to collect 5689 samples from 15 hospitals in Liaocheng from January 2014 to December 2018.Among them,112 carbapenem-resistant Enterobacteriaceae were isolated from clinical specimens.Retrospective study was used to analyze the risk factors of nosocomial infection.The phenotype was confirmed by modified Hodge test,ETP-EDTA synergistic test and mCIM test.The carbapenem gene was amplified by PCR.Results Among 5689 cases,112 carbapenem-resistant Enterobacteriaceae were isolated from clinical specimens,with an incidence of 1.97%.It can be seen that the infection rate of carbapenem-resistant Enterobacteriaceae was significantly different under the conditions of different criticality,underlying diseases,invasive operation,glucocorticoid use and immunosuppressive drugs(P<0.05).Logistic regression analysis model showed that the critical degree(conforming to and admitted to ICU),complicated basic diseases(2 diseases or more),invasive operation,glucocorticoid use and immunosuppressive drugs were independent risk factors of carbapenem-resistant Enterobacteriaceae bacterial infection(OR=1.977,1.558,1.103,1.078 and 1.770,P<0.05).Twenty-six strains of NDM-producing Enterobacteriaceae showed multiple drug resistance,among which 7 strains were resistant to imipenem,8 strains were resistant to ertapenem,6 strains were resistant to meropenem,and 5 strains were sensitive to all three drugs.PCR results showed that 26 strains of Escherichia coli producing NDM were divided into 4 genotypes,including 9 strains of D type,8 strains of B type,5 strains of C type,and 4 strains of A type.Conclusion There are many NDM subtypes in hospitals,and the main infection factors are invasive operation and antibiotic application,which are mainly transmitted among Enterobacteriaceae through X3 plasmid.
作者
田金静
康亚丽
路秀芳
任更朴
TIAN Jinjing;KANG Yali;LU Xiufang;REN Gengpu(Clinical Laboratory,the Second Affiliated Hospital of Shandong First Medical University,the Second People's Hospital of Liaocheng,Shandong,Liaocheng 252600,China)
出处
《中国医药科学》
2021年第10期7-10,60,共5页
China Medicine And Pharmacy
基金
山东省医药卫生科技发展计划项目(2018WS441)。
