碳青霉烯耐药肠杆菌科细菌blaNDM/blaOXA基因型检测在区域传播监控中的临床价值-东南大学学报医学版

碳青霉烯耐药肠杆菌科细菌blaNDM/blaOXA基因型检测在区域传播监控中的临床价值

单位：四川护理职业学院附属医院(四川省第三人民医院), 四川成都 610100

关键词：碳青霉烯耐药肠杆菌科细菌 blaNDM基因 blaOXA基因基因型检测区域传播监控

分类号：R378.4

出版年·卷·期（页码）：2025·44·第六期（898-907）

摘要：

目的: 探讨碳青霉烯耐药肠杆菌科细菌(CRE)中blaNDM和blaOXA基因型分布特征,评估基因型检测在区域传播监控中的临床价值,为临床精准治疗和感染控制提供科学依据。方法: 采用回顾性队列研究方法,纳入2024年1月至2025年3月期间本院365例CRE感染住院患者。采用MALDI-TOF MS进行细菌鉴定,VITEK 2系统检测药敏,多重PCR技术检测blaNDM、blaOXA、blaKPC、blaVIM、blaIMP等碳青霉烯酶基因,阳性产物测序分析基因亚型。收集患者临床资料,分析不同基因型CRE的临床特征、抗菌药物敏感性、传播特征及患者预后。采用多因素Logistic回归分析影响患者30 d死亡的独立危险因素。结果: 365株CRE中肺炎克雷伯菌278株(76.2%),其次为大肠埃希菌49株(13.4%)。blaNDM基因阳性324株(88.8%),主要为blaNDM-1亚型286株(88.3%);blaOXA基因阳性267株(73.2%),主要为blaOXA-48亚型176株(65.9%);双基因阳性248株(67.9%)。双基因阳性组患者恶性肿瘤比例(46.8% vs 32.6%,P=0.021)、ICU住院比例(73.8% vs 52.6%,P<0.001)及机械通气使用率(48.4% vs 29.5%,P=0.003)均显著高于单基因组。与blaNDM单基因阳性组比,双基因阳性菌株对替加环素(58.9% vs 77.6%,P=0.003)和多黏菌素B(54.8% vs 71.1%,P=0.013)的敏感率显著降低。研究期间识别出6起聚集性传播事件,涉及83例患者(22.7%),重症医学科、血液科为高风险科室。双基因阳性组30 d病死率(24.2% vs 13.7%,P=0.029)和住院天数[(31.4±19.8)d vs(22.1±15.3)d,P<0.001]均显著高于单基因组。多因素分析显示,双基因阳性(OR=2.34,95%CI:1.21~4.52,P=0.012)是患者30 d死亡的独立危险因素。结论: blaNDM/blaOXA基因型检测在CRE区域传播监控中具有重要临床价值。双基因阳性CRE感染患者表现出更广泛的耐药性、更高的病死率和更差的临床预后,提示需要更加积极的治疗策略和严格的感染控制措施。基因型检测不仅能够指导精准治疗,还是院内感染控制和流行病学监测的重要工具。

参考文献：

[1] 王健,李轶,白振宇,等.两株携带blaNDM基因肠杆菌目细菌的分子流行病学特征研究[J].中国合理用药探索,2024,21(6):33-39.
[2] LOGAN L K,WEINSTEIN R A.The epidemiology of carbapenem-resistant Enterobacteriaceae:the impact and evolution of a global menace[J].J Infect Dis,2017,215(suppl-1):S28-S36.
[3] 李鑫,杨继勇.碳青霉烯类耐药肠杆菌科细菌分布与流行特征研究进展[J].中华微生物学和免疫学杂志,2019,39(4):306-310.
[4] 刘丽娟,王学,姜梅杰,等.阴沟肠杆菌对碳青霉烯类药物的耐药机制[J].中国感染控制杂志,2021,20(8):681-687.
[5] 温伟洪,梁英健,马芙蓉,等.耐碳青霉烯肠杆菌科细菌碳青霉烯酶检测与多位点序列分型分析[J].检验医学,2019,34(7):577-582.
[6] TUHAMIZE B,BAZIRA J.Carbapenem-resistant Enterobacteriaceae in the livestock,humans and environmental samples around the globe:a systematic review and meta-analysis[J].Sci Rep,2024,14(1):16333.
[7] ROJAS L J,HUJER A M,RUDIN S D,et al.NDM-5 and OXA-181 beta-lactamases,a significant threat continues to spread in the Americas[J].Antimicrob Agents Chemother,2017,61(7):e00454-17.
[8] MONTEIRO J,WIDEN R H,PIGNATARI A C C,et al.Rapid detection of carbapenemase genes by multiplex real-time PCR[J].J Antimicrob Chemother,2012,67(4):906-909.
[9] 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(7):807-811,815.
[10] ZHANG W,GUO Y,LI J,et al.In vitro and in vivo bactericidal activity of ceftazidime-avibactam against Carbapenemase-producing Klebsiella pneumoniae[J].Antimicrob Resist Infect Control,2018,7:142.
[11] SHIELDS R K,MCCREARY E K,MARINI R V,et al.Early experience with meropenem-vaborbactam for treatment of carbapenem-resistant Enterobacteriaceae infections[J].Clin Infect Dis,2020,71(3):667-671.
[12] 刘志武,张甜甜,徐腾飞,等.某医院2020—2021年CRE耐药性及碳青霉烯酶基因分析[J].中国抗生素杂志,2023,48(7):806-812.
[13] HUANG J,LV C,LI M,et al.Carbapenem-resistant Escherichia coli exhibit diverse spatiotemporal epidemiological characteristics across the globe[J].Commun Biol,2024,7(1):51.
[14] 黄雯,王兴纯,唐熙,等.老年维持性血液透析患者多重耐药菌感染病原菌分布情况及其影响因素分析[J].东南大学学报(医学版),2023,42(5):764-768.
[15] EL-KHOLY A T,EL-KHOLY M A,OMAR H,et al.Co-existence of antibiotic resistance and virulence factors in carbapenem resistant Klebsiella pneumoniae clinical isolates from Alexandria,Egypt[J].BMC Microbiol,2024,24(1):466.
[16] POURAKBARI B,MAMISHI S,POORMOHAMMADI S,et al.High prevalence of carbapenem resistance and clonal expansion of bla(NDM) gene in Klebsiella pneumoniae isolates in an Iranian referral pediatric hospital[J].Gut Pathog,2024,16(1):17.
[17] LAZAR D S,NICA M,DASCALU A,et al.Carbapenem-resistant NDM and OXA-48-like producing K.pneumoniae:from menacing superbug to a mundane bacteria; a retrospective study in a Romanian tertiary hospital[J].Antibiotics,2024,13(5):435.
[18] CERÓN S,SALEM-BANGO Z,CONTRERAS D A,et al.Clinical and genomic characterization of carbapenem-resistant Klebsiella pneumoniae with concurrent production of NDM and OXA-48-like carbapenemases in southern California,2016-2022[J].Microorganisms,2023,11(7):1717.
[19] 吴晓燕,李小四,郭建伟,等.内镜逆行胰胆管造影术后感染耐碳青霉烯类肠杆菌耐药特征及临床危险因素分析[J].中国卫生检验杂志,2023,33(11):1323-1327.
[20] TOMCZYK S,ZANICHELLI V,GRAYSON M L,et al.Control of carbapenem-resistant Enterobacteriaceae,Acinetobacter baumannii,and Pseudomonas aeruginosa in healthcare facilities:a systematic review and reanalysis of quasi-experimental studies[J].Clin Infect Dis,2019,68(5):873-884.
[21] BEN-DAVID D,MAOR Y,KELLER N,et al.Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection[J].Infect Control Hosp Epidemiol,2010,31(6):620-626.
[22] AITKEN S L,CLANCY C J.IDSA Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections[J].Clin Infect Dis,2022,74(12):2161-2163.
[23] CHEN J,HU Q,ZHOU P,et al.Ceftazidime-avibactam versus polymyxins in treating patients with carbapenem-resistant Enterobacteriaceae infections:a systematic review and meta-analysis[J].Infection,2024,52(1):19-28.
[24] HAN R,SHI Q,WU S,et al.Dissemination of carbapenemases(KPC,NDM,OXA-48,IMP,and VIM) among carbapenem-resistant Enterobacteriaceae isolated from adult and children patients in China[J].Front Cell Infect Microbiol,2020,10:314.
[25] 沈芳,全晶晶,刘炉香,等.碳青霉烯耐药肠杆菌目细菌耐药性及耐药传播机制研究[J].中华微生物学和免疫学杂志,2021,41(9):679-686.
[26] 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.
[27] 谢晖,曹小利,陈雨欣,等.碳青霉烯耐药大肠埃希菌的药物敏感性、耐药基因及多位点序列分型分析[J].临床输血与检验,2020,22(6):633-637.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录