The carbapenemase genotypes in carbapenem-nonsusceptible Enterobacteriaceae strains

doi:10.3877/cma.j.issn.1674-1358.2018.04.005

Abstract

Abstract:

Objective

To investigate the type of carbapenem gene carried byEnterobacteriaceae bacteriawith low susceptibility to carbapenems.

Methods

Total of 87 carbapenem-nonsusceptibleEnterobacteriaceaestrains isolated from clinical samples in Renmin Hospital of Wuhan University from February 2016 and February 2017 were collected. The phenotypes of carbapenemases were identified by Modified Hodge Test. The carbapenemase genes (blaKPC, blaNDM, blaIMP and blaVIM) were detected by PCR. And the nucleotide sequences were compared with the sequences available by BLAST comparison on NCBI.

Results

The detection rate of carbapenemase-producing strains was 70.1% among 87 carbapenem-nonsusceptibleEnterobacteriaceaestrains. The strains carrying blaKPC-2, blaNDM-1, blaNDM-5, blaIMP-4 and blaVIM-1 were 29 strains, 16 strains, 11 strains, 7 strains and 1 strain, respectively. The most common carbapenemase-producing strains wereKlebsiella pneumoniae(33 strains) and followed byEscherichia coli(15 strains).Klebsiella pneumoniaemainly produced KPC-carbapenemase andEscherichia colionly produced NDM-carbapenemase. The sensitivity, specificity, positive predictive value and negative predictive value of Modified Hodge Test for carbapenemase were 93.4%, 96.2%, 98.3% and 86.2%, respectively. And the insensitivity rates of carbapenem-nonsusceptibleEnterobacteriaceaestrains to imipenem and meropenem were 93.1% and 79.3%, respectively. The resistance rates of KPC and NDM-producingEnterobacteriaceaestrains to penicillins, cephalosporins, carbapenems and compound preparation with enzyme inhibitors were all 100%.

Conclusions

The carbapenem-nonsusceptibleEnterobacteriaceaestrains isolated from our Hospital mainly produced KPC-2, NDM-1 and NDM-5 carbapenemases.

Key words: Carbapenem, Enterobacteriaceae, Modified Hodge test, Carbapenemases, Genotypes

Lina Feng, Congrong Li, Yongwen Yang, Shupeng Jiang, Xuan Cai, Juan Li, Kai Feng, Jing Guo. The carbapenemase genotypes in carbapenem-nonsusceptible Enterobacteriaceae strains[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(04): 334-340.

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References 42

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产物	编码基因	引物序列（5′→3′）	产物长度（bp）	退火温度（℃）
肺炎克雷伯菌碳青霉烯酶	blaKPC	F：ATCGCCGTCTAGTTCTGCTG	811	60
肺炎克雷伯菌碳青霉烯酶	blaKPC	R：TCGCTGTGCTTGTCATCCTT	811	60
新德里金属β-内酰胺酶	blaNDM	F：AGGACAAGATGGGCGGTATG	281	60
新德里金属β-内酰胺酶	blaNDM	R：CTTGGCCTTGCTGTCCTTGA	281	60
亚胺培南水解酶	blaIMP	F：GGGCGGAATAGAGTGGCTTA	365	60
亚胺培南水解酶	blaIMP	R：GTGATGCGTCTCCAGCTTCA	365	60
维罗纳整合子编码金属β-内酰胺酶	blaVIM	F：GAGCCGAGTGGTGAGTATCC	370	60
维罗纳整合子编码金属β-内酰胺酶	blaVIM	R：GAATCTCGTTCCCCTCTGCC	370	60

产物	编码基因	引物序列（5′→3′）	产物长度（bp）	退火温度（℃）
肺炎克雷伯菌碳青霉烯酶	blaKPC	F：ATCGCCGTCTAGTTCTGCTG	811	60
肺炎克雷伯菌碳青霉烯酶	blaKPC	R：TCGCTGTGCTTGTCATCCTT	811	60
新德里金属β-内酰胺酶	blaNDM	F：AGGACAAGATGGGCGGTATG	281	60
新德里金属β-内酰胺酶	blaNDM	R：CTTGGCCTTGCTGTCCTTGA	281	60
亚胺培南水解酶	blaIMP	F：GGGCGGAATAGAGTGGCTTA	365	60
亚胺培南水解酶	blaIMP	R：GTGATGCGTCTCCAGCTTCA	365	60
维罗纳整合子编码金属β-内酰胺酶	blaVIM	F：GAGCCGAGTGGTGAGTATCC	370	60
维罗纳整合子编码金属β-内酰胺酶	blaVIM	R：GAATCTCGTTCCCCTCTGCC	370	60

抗菌药物	87株肠杆菌科细菌比例			产KPC肠杆菌科细菌株数比例			产NDM肠杆菌科细菌株数比例
抗菌药物	R	I	S	R	I	S	R	I	S
氨苄西林	100.0	0.0	0.0	100.0	0.0	0.0	100.0	0.0	0.0
哌拉西林	87.7	3.7	8.6	100	0.0	0.0	100.0	0.0	0.0
氨苄西林/舒巴坦	93.6	3.2	3.2	100.0	0.0	0.0	100.0	0.0	0.0
阿莫西林/克拉维酸	96.9	3.1	0.0	100.0	0.0	0.0	100.0	0.0	0.0
哌拉西林/他唑巴坦	80.5	3.4	16.1	100.0	0.0	0.0	100.0	0.0	0.0
头孢唑林	98.8	1.2	0.0	100.0	0.0	0.0	100.0	0.0	0.0
头孢他啶	87.2	0	12.8	100.0	0.0	0.0	100.0	0.0	0.0
头孢噻肟	84.9	3.5	11.6	100.0	0.0	0.0	100.0	0.0	0.0
头孢吡肟	79.4	1.1	19.5	96.6	0.0	3.4	100.0	0.0	0.0
氨曲南	73.3	4.7	22.0	100.0	0.0	0.0	70.4	3.7	25.9
亚胺培南	78.2	14.9	6.9	100.0	0.0	0.0	100.0	0.0	0.0
美罗培南	74.7	4.6	20.7	100.0	0.0	0.0	100.0	0.0	0.0
庆大霉素	65.5	0.0	34.5	75.9	0.0	24.1	85.2	0.0	14.8
阿米卡星	34.5	0.0	65.5	69.0	0.0	31.0	22.2	0.0	77.8
环丙沙星	74.4	5.8	19.8	100.0	0.0	0.0	85.2	7.4	7.4
左氧氟沙星	70.1	2.3	27.6	100.0	0.0	0.0	81.5	0.0	18.5
莫西沙星	73.5	4.1	22.4	100.0	0.0	0.0	84.2	5.3	10.5
复方新诺明	51.2	0.0	48.8	14.3	0.0	85.7	88.9	0.0	11.1
氯霉素	49.3	16.0	34.7	52.2	26.1	21.7	50.0	12.5	37.5
四环素	52.4	0.0	47.6	22.2	0.0	77.8	76.0	0.0	24.0

抗菌药物	87株肠杆菌科细菌比例			产KPC肠杆菌科细菌株数比例			产NDM肠杆菌科细菌株数比例
抗菌药物	R	I	S	R	I	S	R	I	S
氨苄西林	100.0	0.0	0.0	100.0	0.0	0.0	100.0	0.0	0.0
哌拉西林	87.7	3.7	8.6	100	0.0	0.0	100.0	0.0	0.0
氨苄西林/舒巴坦	93.6	3.2	3.2	100.0	0.0	0.0	100.0	0.0	0.0
阿莫西林/克拉维酸	96.9	3.1	0.0	100.0	0.0	0.0	100.0	0.0	0.0
哌拉西林/他唑巴坦	80.5	3.4	16.1	100.0	0.0	0.0	100.0	0.0	0.0
头孢唑林	98.8	1.2	0.0	100.0	0.0	0.0	100.0	0.0	0.0
头孢他啶	87.2	0	12.8	100.0	0.0	0.0	100.0	0.0	0.0
头孢噻肟	84.9	3.5	11.6	100.0	0.0	0.0	100.0	0.0	0.0
头孢吡肟	79.4	1.1	19.5	96.6	0.0	3.4	100.0	0.0	0.0
氨曲南	73.3	4.7	22.0	100.0	0.0	0.0	70.4	3.7	25.9
亚胺培南	78.2	14.9	6.9	100.0	0.0	0.0	100.0	0.0	0.0
美罗培南	74.7	4.6	20.7	100.0	0.0	0.0	100.0	0.0	0.0
庆大霉素	65.5	0.0	34.5	75.9	0.0	24.1	85.2	0.0	14.8
阿米卡星	34.5	0.0	65.5	69.0	0.0	31.0	22.2	0.0	77.8
环丙沙星	74.4	5.8	19.8	100.0	0.0	0.0	85.2	7.4	7.4
左氧氟沙星	70.1	2.3	27.6	100.0	0.0	0.0	81.5	0.0	18.5
莫西沙星	73.5	4.1	22.4	100.0	0.0	0.0	84.2	5.3	10.5
复方新诺明	51.2	0.0	48.8	14.3	0.0	85.7	88.9	0.0	11.1
氯霉素	49.3	16.0	34.7	52.2	26.1	21.7	50.0	12.5	37.5
四环素	52.4	0.0	47.6	22.2	0.0	77.8	76.0	0.0	24.0

碳青霉烯酶基因检测	改良Hodge试验		合计
碳青霉烯酶基因检测	+	－	合计
+	57	4	61
－	1	25	26
合计	58	29	87

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