碳青霉烯类耐药雷氏普罗威登斯菌的出现及其耐药机制研究.docVIP

碳青霉烯类耐药雷氏普罗威登斯菌的出现及其耐药机制研究 夏 淑，肖书念，张 琴，赵倩瑜，林倍州，黄增光，卓 超，陈荣昌 （510120广州，广州医科大学第一附属医院，广州呼吸疾病研究所） [摘要] 目的 报道1株临床分离产NDM-1酶雷氏普罗威登斯菌（FR90），并研究其耐药机制。方法 对菌株进行药物敏感实验，改良Hodge实验检测金属β内酰胺酶，PCR扩增碳青霉烯水解酶基因。采用质粒接合实验、质粒不相容群检测、S1酶切脉冲场电泳和blaNDM-1杂交、基因测序等分析携blaNDM-1质粒特征和基因环境。结果 菌株FR90对氟喹诺酮类、多粘菌素B、β内酰胺类（包括碳青霉烯类）抗生素耐药，对氨曲南敏感。改良Hodge实验阳性，PCR检测几种常见碳青霉烯水解酶基因，结果仅blaNDM-1基因阳性。接合实验显示blaNDM-1基因位于一可接合性质粒上，质粒不相容群分型属于A/C型，Southern杂交结果显示质粒大小约为50 kb。对质粒上大小约为17kb基因片段测序结果示，ISAba125位于blaNDM-1基因两侧，下游依次为trpF、groS、groL基因和insE 基因的一部分。结论 中国大陆出现临床分离产NDM-1酶雷氏普罗威登斯菌，警示我国需对产NDM-1细菌进行严密监测，并采取感染控制措施以阻断耐药基因在细菌之间传播。 [关键词] 普罗威登斯菌，雷氏；金属β内酰胺酶；blaNDM-1基因 [中图法分类号] [文献标志码] A Emergence of carbapenem resistant Providencia rettgeri and study of its resistance mechanisms Xia Shu, Xiao Shunian, Zhang Qin, Zhao Qianyu, Lin Beizhou, Huang Zengguang, Zhuo Chao, Chen Rongchang（Guangzhou Institute of Respiratory Diseases,First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province,510120,China） [Abstract] Objective To report a clinical isolation of NDM-1-Producing Providencia rettgeri（FR90）and study its resistance mechanisms. Methods The bacterial strain was progressed with the antimicrobial Susceptibility test. Production of metallo-β-lactamase was identified by Modified Hodge test. PCR was used to detect several common resistance genes for carbapenemases. Plasmids conjugation，plasmid incompatibility group detection, S1-PFGE ,Southern blot and gene sequencing were conducted to analyse plasmid characteristics and the surrounding genetic structure of the blaNDM-1 gene. Results Providencia rettgeri (FR90) resistant to quinolones, Polymyxin B, and all β-lactams (including carbapenems) except aztreonam. Modified Hodge test showed positive. PCR displayed that only the blaNDM-1 gene was detected among several common resistance genes for carbapenemases. Further study revealed this blaNDM-1 located on a broad host-range IncA/C-type conjugative plasmid FR90 with the