中国某大学医院重症监护病房和呼吸科患者碳青霉烯类耐药菌株的分子流行病学及机制
Molecular Epidemiology and Mechanisms of Carbapenem-Resistant Isolates from ICU and Respiratory Department Patients of a Chinese University Hospital.
作者信息
Liu Bin, Liu Lei
机构信息
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
出版信息
Infect Drug Resist. 2021 Feb 25;14:743-755. doi: 10.2147/IDR.S299540. eCollection 2021.
BACKGROUND
The objective of our study is to estimate the differences in molecular epidemiology and resistance mechanisms in carbapenem-resistant (CRAB) isolates from the ICU and respiratory department(RD) in Fourth Affiliated Hospital of Harbin Medical University.
METHODS
Carbapenemase genes associated with carbapenem resistance were studied by polymerase chain reaction(PCR). Genotyping was analyzed using multi-locus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE).
RESULTS
Sixty non-duplicate CRAB isolates from the ICU and RD (n=30, respectively) were collected. All of CRAB strains were not resistant to colistin (0%). The CRAB strains from the ICU were significantly more resistant to tigecycline and cefoperazone/sulbactam compared with the RD (23.3% vs 0%, P=0.03; 53.3% % vs 23.3%, P=0.01, respectively). PCR detection of genes associated with CRAB revealed that the ratio in both the ICU and the RD of VIM-2, IMP-4, NDM-1, OXA-23, , and mutation of were present in 23.3% vs 0% (P=0.01), 40% vs 10% (P=0.02), 20% vs 0% (P=0.02), 80% vs 56.7%, 16.7% vs 13.3% and 86.7% vs 60% (P=0.04), respectively. Seven genotypes were detected by the PFGE in the RD and the ICU, respectively. Genotype I was significantly more frequent in the ICU compared with the RD (63.3% vs 36.6%, P=0.03). MLST showed that there were 10 ST genotypes in the RD and four in the ICU, but ST92 in both groups was 33.3% vs 63.3% (P=0.03), respectively.
CONCLUSION
There are differences in molecular epidemiology and resistance mechanisms in the CRAB isolates between the ICU and RD.
背景
我们研究的目的是评估哈尔滨医科大学附属第四医院重症监护病房（ICU）和呼吸科（RD）耐碳青霉烯类鲍曼不动杆菌（CRAB）分离株在分子流行病学和耐药机制方面的差异。
方法
采用聚合酶链反应（PCR）研究与碳青霉烯类耐药相关的碳青霉烯酶基因。使用多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）进行基因分型分析。
结果
从ICU和RD分别收集了60株非重复的CRAB分离株（各30株）。所有CRAB菌株对黏菌素均不耐药（0%）。与RD相比，ICU的CRAB菌株对替加环素和头孢哌酮/舒巴坦的耐药性显著更高（分别为23.3%对0%，P = 0.03；53.3%对23.3%，P = 0.01）。对与CRAB相关基因的PCR检测显示，VIM - 2、IMP - 4、NDM - 1、OXA - 23以及的突变在ICU和RD中的比例分别为23.3%对0%（P = 0.01）、40%对10%（P = 0.02）、20%对0%（P = 0.02）、80%对56.7%、16.7%对13.3%以及86.7%对60%（P = 0.04）。PFGE在RD和ICU中分别检测到7种基因型。与RD相比，基因型I在ICU中更为常见（63.3%对36.6%，P = 0.03）。MLST显示，RD中有十种ST基因型，ICU中有四种，但两组中的ST92分别为33.3%对63.3%（P = 0.03）。
结论
ICU和RD的CRAB分离株在分子流行病学和耐药机制方面存在差异。
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