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儿童肠球菌耐万古霉素表型和耐药基因检测分型的研究
张彩虹,张学忠
0
(淄博市中心医院)
摘要:
【摘要】 目的 研究儿科住院患者耐万古霉素肠球菌(VRE)定植菌耐药基因型与表型,了解菌种构成、耐药基因型与表型特点,为儿科临床感染诊断、合理用药提供依据。方法 采集2016年1月~12月期间于淄博市中心医院儿科住院患儿的170个肛门拭子,接种培养,筛选出耐万古霉素肠球菌株,采用琼脂稀释法测定万古霉素、替考拉宁、利奈唑胺、青霉素、庆大霉素、环丙沙星、米诺环素、氨苄西林8个药物对耐万古霉素肠球菌的最低抑菌浓度。提取肠球菌的DNA,PCR法检测耐万古霉素肠球菌耐药基因型及菌种,产物经2%琼脂糖凝胶电泳、成像分析及基因测序。结果 170个拭子培养中共筛选出21株耐万古霉素肠球菌(124%),对大部分测定的抗菌药物耐药率超过50%,包括环丙沙星(905%)、 青霉素(810%)、 氨苄西林(762%)、庆大霉素(HLAR 619%),但仍对利奈唑胺 (100%)与米诺环素(952%)敏感。21株VRE菌种包括屎肠球菌最常见为667%。经PCR检测vanA基因型是本研究中VRE最常见的耐药基因型。追踪VRE定植阳性者,未发现VRE感染。结论 耐万古霉素肠球菌以屎肠球菌最常见。VRE耐大部分抗菌药物,但对利奈唑胺、米诺环素较敏感,可作为治疗VRE感染的选择药物。 本研究中vanA基因型最常见,临床分离菌存在基因型与表型不一致菌株,临床在使用抗菌药物治疗中应予重视。
关键词:  耐万古霉素肠球菌  定植  表型  基因型
DOI:
基金项目:山东省医药卫生科技发展计划(2016WS0745)
Detection of phenotype and genotype of vancomycin resistant Enterococci in children
ZHANG Caihong,ZHANG Xuezhong
(Central Hospital of Zibo)
Abstract:
【Abstract】 Objective The aim of this study was to assay phenotype and genotype of vancomycin resistant enterococci(VRE) colonization strains that had been isolated from inpatient in hematology department and infectious disease department, investigate the features of VRE species constitution, resistant phenotypes and genotypes and provide evidences for clinical diagnosis, rational use of antimicrobials in VRE infections.Methods 170 rectal swabs were collected between January 2016 and December 2016 in pediatric department of Central Hospital of Zibo. VRE colonization was screened by inoculation and incubation. Minimum inhibitory concentrations of vancomycin, teicoplanin, linezolid, penicillin, gentamicin, ciprofloxacin, minocycline and ampicillin against VRE were detected by 2fold agar dilution method. The PCR amplification fragments were identified from their sizes in ethidium bromidestained 2% agarose gels and sequencing of amplicated gene fragments. Results 21 (124%) VRE strains were recovered from 170 rectal swabs. The antimicrobials resistant rates of VRE strains to the most of the determinated antimicrobials in this research was more than 50%,inclouding ciprofloxacin(905%), penicillin(81%), ampicillin(762%), gentamicin(HLAR 619%). The sensitive rate to linezolid was 100% and sensitive rate to minocycline was 952%. 15 out of 21 strains of VRE were Enterococcus faecium 667%(14/21). Genotypes of 21 strains of VRE were detected by PCR. That consisted of 18 strains of vanA. The patients with VRE colonization were followed up, nobody was found with VRE infection.Conclusion In our study, the most common strain of VRE was Enterococcus faecium, account for 667%. In vitro drug susceptibility tests suggested that VRE strains resistant to most antimicrobial agents, but still sensitive to linezolid rate and minocycline with sensitive rates>90%, which can be candidates for chemotherapy for VRE infections. vanA was the most common genotype in the study of VRE strains. The more attentions should be paid to the disagreement between phenotype and genotype in clinical monitoring of VRE infections.
Key words:  VRE  Colonization  Phenotype  Genotype6

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