标题：东莞地区肠杆菌科细菌碳青霉烯酶的表型与基因型分析

      作者：黄亚 1，谢树金 1，林偲思 1，朱艳 2，王套瑞 1，吕飞 3，程理维 1，方颖 1，黄晓君 1，谢佩 1，陈青诗 1，郭主声 1    1.中山大学附属东莞东华医院检验科，广东 东莞 523110；2.广东医科大学基础医学院寄生虫教研室，广东 湛江 524000；3.广东医科大学基础医学院微生物与免疫教研室，广东 湛江 524000

      卷次： 2022年33卷10期

      【摘要】 目的 了解东莞地区耐碳青霉烯类肠杆菌科细菌(CRE)临床感染分布、耐药情况以及产碳青霉烯酶的表型与基因型，完善东莞地区耐药监测信息，为临床控制和治疗CRE的感染提供可靠依据。方法 使用VITEK2 Compact全自动细菌鉴定药敏系统分析仪系统对东莞耐药监测网2020年收集的40株CRE菌株进行菌种鉴定与药敏试验，采用纸片扩散法(K-B法)和E-test法测定药敏。采用碳青霉烯酶抑制剂增强试验检测碳青霉烯酶表型，采用GeneXpert Carba-R检测和鉴定碳青霉烯酶的基因型。使用WHONET 5.6软件和SPSS23.0软件进行统计分析。结果 40株CRE菌株中检出最高的是肺炎克雷伯菌27株(占67.5%)，其次是大肠埃希菌10株(占25%)；标本中检出率最高的是呼吸道标本(16株，占40%)，其次是尿液标本(7株，占17.5%)；40株CRE药敏结果显示，亚胺培南的耐药率为92.5%，美罗培南的耐药率为97.5%，替加环素的耐药率较低为40%；碳青霉烯酶型检测结果显示有37株(占92.5%)产生碳青霉烯酶，其中产A类丝氨酸碳青霉烯酶阳性 24株(占60.0%)，产B类金属β内酰胺酶阳性13株(占 32.5%)，未检出碳青霉烯酶菌株 3株(占 7.5%)；GeneXpert Carba-R测定法检测出碳青霉烯酶基因共 37株(占92.5%)，检出13株 blaNDM (占32.5%)，24株 blaKPC (占60%)；携带 blaKPC的CRE菌株对阿米卡星、替加环素和氨曲南的耐药率比携带 blaNDM的CRE菌株的高，差异有统计学意义(P<0.05)。结论 东莞地区分离的CRE菌株以产A类丝氨酸碳青霉烯酶和产B类金属β-内酰胺酶的菌株为主。检出的碳青霉烯酶基因型主要为 blaNDM和blaKPC，其中携带 blaNDM的CRE菌株对阿米卡星、替加环素和氨曲南的耐药率较低。GeneXpert Carba-R可以快速检测并鉴定碳青霉烯酶基因型。建议实验室同时进行表型和基因型的检测，指导临床合理使用抗生素。
      【关键词】 耐碳青霉烯类肠杆菌科细菌；碳青霉烯酶抑制剂增强试验；肺炎克雷伯氏菌碳青霉烯酶；新德里金属-β-内酰胺酶
      【中图分类号】 R378.2 【文献标识码】 A 【文章编号】 1003—6350（2022）10—1270—05

Phenotype and genotype analysis of Carbapenase of enterobacteriaceae bacteria in Dongguan.
HUANG Ya 1, XIEShu-jin 1, LIN Si-si 1, ZHU Yan 2, WANG Tao-rui 1, LV Fei 3, CHENG Li-wei 1, FANG Ying 1, HUANG Xiao-jun 1, XIE Pei 1,CHEN Qing-shi 1, GUO Zhu-sheng 1. 1. Department of Laboratory Medicine, Dongguan Donghua Hospital Affiliated to SunYat-sen University, Dongguan 523110, Guangdong, CHINA; 2. Department of Parasites, College of Basic Medicine,Guangdong Medical University, Zhanjiang 524000, Guangdong, CHINA; 3. Department of Microbiology and Immunology,College of Basic Medicine, Guangdong Medical University, Zhanjiang 524000, Guangdong, CHINA
【Abstract】 Objective To understand the distribution of clinical infection, drug resistance, and the phenotypeand genotype of carbapenem-resistant Enterobacteriaceae (CRE) bacteria in Dongguan, improve the monitoring informa-tion of drug resistance in Dongguan, and provide reliable basis for clinical control and treatment of CRE infection.Methods A total of 40 CRE strains collected by Dongguan Drug Resistance Monitoring Network in 2020 were identi-fied and tested by VITEK 2 Compact automatic bacterial identification and drug sensitivity system analyzer. Antimicrobi-al susceptibility testing was determined by disk diffusion method (K-B method) and E-test method. The phenotype of car-bapenem was detected by carbapenem inhibitor enhancement test, and the genotype of carbapenem was detected andidentified by GeneXpert Carba-R. The WHONET 5.6 software and SPSS23.0 software were used for statistical analysis.Results Among the 40 CRE strains, Klebsiella pneumoniae (27 strains, accounting for 67.5%) were the mostly detected,followed by Escherichia coli (10 strains, accounting for 25%). Among the specimens, the highest detection rate was in re-spiratory specimens (16 strains, accounting for 40%), followed by urine specimens (7 strains, accounting for 17.5%).The drug sensitivity results of 40 CRE strains showed that the antibiotic resistance rate of imipenem, meropenem, and ti-gecycline were 92.5%, 97.5%, 40%, respectively. Results showed that 37 strains (accounting for 92.5%) produced car-bapenemase, of which 24 strains (accounting for 60%) produced class A serine carbapenemase, and 13 strains (account-ing for 32.5%) were positive for class B metallo-β-lactamasee, and 3 strains (accounting for 7.5%) were not detectedwith carbapenemases. A total of 37 carbapenemase genes (accounting for 92.5%) were detected by the GeneXpert Car-ba-R assay, including blaNDM (13 strains, accounting for 32.5%) and blaKPC (24 strains, accounting for 60%). CRE