摘要：目的 研究肠杆菌科细菌耐药率变化趋势及碳青霉烯酶blaNDM和blaKPC基因型和耐药基因。方法 本研究以2017年1月至2023年12月在我院治疗的患者700例肠杆菌科细菌感染患者作为研究对象，其中符合美国临床和实验室标准协会(CLSI)2015版为判定标准的肠杆菌科细菌耐药感染患者350例作为研究对象（研究组），非肠杆菌科细菌耐药感染患者350例作为对照组。研究肠杆菌科细菌耐药危险因素，分析肠杆菌科细菌耐药感染的变化趋势，讨论肠杆菌科细菌耐药情况，研讨肠杆菌科细菌耐药基因分布。结果 研究组以及对照组的高血压（χ2=57.461，P=0.000）、糖尿病（χ2=5.079，P=0.024）、高脂血症（χ2=7.451，P=0.007）、慢性阻塞性肺病（χ2=47.801，P=0.000）、住院时间（t=66.029，P=0.000）、APACHEⅡ评分（t=59.462，P=0.000）、机械通气时间（t=70.986，P=0.000）、使用抗生素种类（t=37.951，P=0.000）、气管插管（χ2=8.721，P=0.003）、留置尿管（χ2=16.641，P=0.000）、应用糖皮质激素（χ2=6.091，P=0.014）、白蛋白（t=104.655，P=0.000）之间的差异存在统计学意义（P＞0.05），详见表1。通过多因素分析，高血压(OR=0.313)、糖尿病(OR=0.320)、高脂血症(OR=0.299)、慢性阻塞性肺病(OR=0.362)、住院时间(OR=0.339)、APACHEⅡ评分(OR=0.351)、机械通气时间(OR=0.345)、使用抗生素种类(OR=0.303)、气管插管(OR=0.349)、留置尿管(OR=0.359)、应用糖皮质激素(OR=0.339)、白蛋白(OR=0.318)均是造成患者肠杆菌科细菌耐药感染的危险因素，通过对2017年-2023年的呼吸科、重症监护室、神经内科肠杆菌科细菌耐药感染情况的变化趋势进行分析，2017年-2023年的呼吸科
Abstract
Abstract: objective:To investigate the trends in resistance rates of Enterobacteriaceae bacteria and analyze the carbapenemase genes blaNDM and blaKPC as well as resistant genes. Methods: This study included 700 patients with Enterobacteriaceae bacterial infections treated at our hospital from January 2017 to December 2023. Among them, 350 patients with Enterobacteriaceae bacterial infections who met the criteria of the Clinical and Laboratory Standards Institute (CLSI) 2015 edition were selected as the study group, and 350 non-resistant patients were selected as the control group. The risk factors for resistance of Enterobacteriaceae bacteria, trends in resistance rates, the resistance situation of Enterobacteriaceae bacteria, and the distribution of resistance genes were analyzed. Results:Statistical significance was observed in the differences between the study group and the control group in terms of hypertension (χ2=57.461, P=0.000), diabetes (χ2=5.079, P=0.024), hyperlipidemia (χ2=7.451, P=0.007), chronic obstructive pulmonary disease (χ2=47.801, P=0.000), duration of hospitalization (t=66.029, P=0.000), APACHE II score (t=59.462, P=0.000), duration of mechanical ventilation (t=70.986, P=0.000), types of antibiotics used (t=37.951, P=0.000), endotracheal intubation (χ2=8.721, P=0.003), urinary catheterization (χ2=16.641, P=0.000), use of glucocorticoids (χ2=6.091, P=0.014), and albumin levels (t=104.655, P=0.000) (P＞0.05). Refer to Table 1 for details. Multifactorial analysis revealed that hypertension (OR=0.313), diabetes (OR=0.320), hyperlipidemia (OR=0.299), chronic obstructive pulmonary disease (OR=0.362), duration of hospitalization (OR=0.339), APACHE II score (OR=0.351), duration of mechanical ventilation (OR=0.345), types of antibiotics used (OR=0.303), endotracheal intubation (OR=0.349), urinary catheterization (OR=0.359), use of glucocorticoids (OR=0.339), and albumin levels (OR=0.318) were all identified as risk factors for Enterobacteriaceae bacterial resistance in patients.Analysis of the trends in Enterobacteriaceae bacterial resistance in the respiratory department, intensive care unit, and neurology department from 2017 to 2023 showed a significant upward trend in the respiratory department (χ2=14.307, P=0.000), intensive care unit (χ2=17.864, P=0.000), and neurology department (χ2=13.763, P=0.000). Analysis of Enterobacteriaceae bacterial resistance revealed resistance primarily to ceftriaxone, ciprofloxacin, levofloxacin, piperacillin, and
关键词
关键词： 肠杆菌科细菌耐药 /
基因分型 /
blaKPC /
blaNDM-1 /
blaSME
Key words
Keywords: Enterobacteriaceae bacteria drug resistance /
Genotyping /
blaKPC /
blaNDM-1 /
blaSME
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参考文献
参考文献
[1]宗劲,徐凯进,黄莹,等.质粒介导黏菌素耐药机制研究进展[J].中国微生态学杂志,2021,33(01):120-125.DOI:10.13381/j.cnki.cjm.202101024.
[2]李东明,王宇凡,武玉晶,等.耐碳青霉烯革兰阴性杆菌耐药性及基因分型[J].中华医院感染学杂志,2021,31(06):816-820.
[3]郭玲,王美玲,叶丽艳,等.某院2017-2018年耐碳青霉烯类肠杆菌科细菌检测及分析[J].国际检验医学杂志,2021,42(07):807-811+815.
[4]陈晨,周俊英,李一荣,等.耐碳青霉烯类肠杆菌科细菌的耐药基因及同源性分析[J].分子诊断与治疗杂志,2021,13(05):683-686.DOI:10.19930/j.cnki.jmdt.2021.05.002.
[5]B D ,M S S ,K T D .Detection of Quinolone resistance Qnr genes and its association with Extended Spectrum β-lactamase and AmpC β-lactamase genes in Qnr Positive Enterobacteriaceae in Bangladesh.[J].Mymensingh medical journal : MMJ,2024,33(1):183-191.
[6]Lee I ,Jo W J ,Woo J H , et al.Proton pump inhibitors increase the risk of carbapenem-resistant Enterobacteriaceae colonization by facilitating the transfer of antibiotic resistance genes among bacteria in the gut microbiome.[J].Gut microbes,2024,16(1):2341635-2341635.
[7]Xin’er Z ,Dingting X ,Jinchang Y , et al.Mobile genetic elements facilitate the transmission of antibiotic resistance genes in multidrug-resistant Enterobacteriaceae from duck farms[J].Food Science and Human Wellness,2024,13(2):729-735.
[8]特尼格尔,孙建文,姜小华,等.耐碳青霉烯类肠杆菌科细菌耐药基因分析[J].中国卫生检验杂志,2021,31(10):1192-1196.
[9]Baguy M O ,Wognin S A ,Anatole A T , et al.Role of Healthy Human Gut Microbiota in the Emergence and Dissemination of Extended-Spectrum β-lactamase-Producing Enterobacteriaceae and Genes Associated with β-lactam Resistance in Community Settings in Abidjan, C?te d'Ivoire[J].Microbiology Research Journal International,2023,33(7):27-37.
[10]王亮亮.猪源主要肠杆菌科细菌替加环素耐药基因tet（X）变异体的流行与传播特征研究[D].河南农业大学,2021.DOI:10.27117/d.cnki.ghenu.2021.000471.
[11]Rezaul M K ,Zunita Z ,Latiffah H , et al.Antimicrobial Resistance Profiles and Co-Existence of Multiple Antimicrobial Resistance Genes in mcr-Harbouring Colistin-Resistant Enterobacteriaceae Isolates Recovered from Poultry and Poultry Meats in Malaysia.[J].Antibiotics (Basel, Switzerland),2023,12(6):1-2.
[12]CaiHong G ,YuQing L ,Yan L , et al.High prevalence and genomic characteristics of carbapenem-resistant Enterobacteriaceae and colistin-resistant Enterobacteriaceae from large-scale rivers in China.[J].Environmental pollution (Barking, Essex : 1987),2023,331(P2):121869-121869.
[13]Hafiz M S N ,K. S ,Ab S Y , et al.THE CARBAPENEMASE PRODUCING CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CP-CRE) GENE DISTRIBUTION IN MALAYSIA (2016 – 2021): A REPORT[J].International Journal of Infectious Diseases,2023,130(S2):S133-S133.
[14]Wiebke B ,Baban K ,Vera J , et al.Bacterial genome sequencing tracks the housefly-associated dispersal of fluoroquinolone- and cephalosporin-resistant Escherichia coli from a pig farm.[J].Environmental microbiology,2023,25(6):11-13.
[15]艾杨,刘丽.耐碳青霉烯类抗菌药物的肠杆菌科细菌耐药基因型分析及治疗[J].齐齐哈尔医学院学报,2021,42(14):1201-1207.
[16]Tsepo R ,Mpho T ,E K L , et al.Antimicrobial resistance genes of Escherichia coli, a bacterium of "One Health" importance in South Africa: Systematic review and meta-analysis.[J].AIMS microbiology,2023,9(1):75-89.
[17]张玉敏,顾全,韩素桂,等.碳青霉烯类耐药肠杆菌科细菌耐药基因分型与临床感染分析[J].热带医学杂志,2022,22(12):1656-1660.
[18]Nieko D M P N ,Morabandza J C ,KayaOngoto D M , et al.First Detection of Fluoroquinolones and Aminoglycosides Resistance Genes in Multiresistant Enterobacteriaceae from Urinary Tract Infections[J].American Journal of Infectious Diseases and Microbiology,2022,10(4):131-138.
[19]Pegah K ,Tatsuya T ,Satoshi O , et al.Modified Drug-Susceptibility Testing and Screening Culture Agar for Colistin-Susceptible Enterobacteriaceae Isolates Harboring a Mobilized Colistin Resistance Gene mcr-9.[J].Journal of clinical microbiology,2022,60(12):e0139922-e0139922.
[20]Jin T ,Dejun L ,Jincheng X , et al.Rapid On-Site Detection of Extensively Drug-Resistant Genes in Enterobacteriaceae via Enhanced Recombinase Polymerase Amplification and Lateral Flow Biosensor.[J].Microbiology spectrum,2022,10(6):e0334422-e0334422.
[21]S H ,S F ,S M A , et al.Genetic heterogeneity and predominance of blasubCTX-M/sub sub-15/sub in cefotaxime-resistant Enterobacteriaceae isolates colonizing hospitalized children in Tunisia.[J].Letters in applied microbiology,2022,75(6):1460-1474.
[22]宋婵婵.河南省某三甲医院耐碳青霉烯类肠杆菌科细菌耐药性及耐药基因分析[J].河南预防医学杂志,2022,33(07):541-543.DOI:10.13515/j.cnki.hnjpm.1006-8414.2022.07.016.
[23]房锐颖,张亚萍,陶云珍,等.苏州大学附属儿童医院碳青霉烯类耐药肠杆菌目细菌流行特征及耐药基因分析[J].安徽医学,2022,43(03):271-275.
[24]崔小璠,刘蕊,刘慧敏,等.2017-2019年某院肠杆菌科细菌检出特征及耐药基因检测[J].中华医院感染学杂志,2021,31(16):2411-2415.
[25]时芳芳,李轶,韦慧玲,等.某医院临床分离耐碳青霉烯类肠杆菌科细菌耐药特点及耐药基因分析[J].中国消毒学杂志,2021,38(12):896-899.
[26]曾利娟.某院产超广谱β内酰胺酶肠杆菌目细菌的耐药性及基因型分析[J].中国药物与临床,2021,21(22):3775-3777.
基金
邢台市重点研发计划项目：以阳性血培养为基质肠杆菌科细菌碳青霉烯酶快速检测方法的研究
