利奈唑胺耐药肠球菌的分子流行病学和感染危险因素分析
The molecular epidemiology and infections risk factors of clinical linezolid-resistant Enterococci isolates
贾晓炯 1徐绣宇 1马维佳 1史静 1张莉萍1
作者信息
- 1. 400016 重庆医科大学附属第一医院检验科实验室
- 折叠
摘要
目的 探究利奈唑胺耐药肠球菌(LRE)的分子流行病学特点和感染危险因素.方法 2011至2013年共收集重庆医科大学附属第一医院13株利奈唑胺耐药肠球菌,采用微量肉汤稀释法对菌株进行验证,并通过法国生物梅里埃Vitek 2对12种抗生素进行MIC检测;多位点序列分型(MLST)、脉冲场凝胶电泳(PFGE)、Diversilab进行分子流行病学调查;对患者病例资料进行回顾性分析,采用Logistic回归模型来明确利奈唑胺耐药肠球菌的独立危险因素.结果 13株利奈唑胺耐药肠球菌均对利奈唑胺呈现低水平耐药,对四环素、红霉素、环丙沙星多表现耐药,对青霉素、氨苄西林、替加环素等多表现敏感;我院以ST480型别为主,其中2013年7至9月有3株菌(菌株3～5)具有相同的序列分型(ST)型别、PFGE条带和rep-PCR分型结果,属于同一耐药克隆群;入住ICU、周围血管疾病、男性、低蛋白血症、肠道灌洗和利奈唑胺使用等是利奈唑胺耐药肠球菌的主要危险因素,其中,入住ICU(OR=8.74;P =0.008)、肠道灌洗(OR=8.39;P=0.015)、利奈唑胺使用(OR=10.19;P =0.039)是其独立危险因素.结论 13株LRE均为多重耐药菌株,2013年下半年存在小规模的LRE流行,应重视LRE的监管工作,从而减少利奈唑胺耐药菌株的出现.
Abstract
Objective To investigate the molecular epidemiology and infectious risk factors of linezolid-resistant Enterococci (LRE) isolates in the First Affiliated Hospital of Chongqing Medical University.Methods Thirteen LRE isolates were collected from 2011 to 2013 and confirmed by broth dilution susceptibility testing.The minimum inhibitory concentrations (MIC) of twelve antimicrobial agents were analyzed using Vitek 2 compact.The molecular epidemiology of LRE isolates was determined by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) and the Diversilab.A casecontrol study was conducted for the analysis of risk factors, and Logistic regression was performed to evaluate the independent risk factors.Results All thirteen LRE isolates showed low-level resistance to linezolid, and most of these isolates were resistant to tetracycline, erythromycin and ciprofloxacin.However, they had high sensitivity to penicillin, ampicillin and tigecycline.Sequence type 480 was predominant in the hospital, and three isolates (isolates 3, 4, and 5) from July to September 2013 were found to have the same ST, PFGE pattern and rep-PCR group, indicating the same resistance clone.Admission to intensive care unit (ICU), peripheral vascular disease, males, hypoalbuminaemia, enema and linezolid therapy were identified as significant risk factors for LRE infections.Among these factors, admission to ICU, enema and linezolid therapy were independent risk factors for the acquisition of LRE.Conclusions Thirteen LRE isolates collected in the hospital showed a multidrug-resistant phenotype, and a small-scale prevalence was detected from 2011 to 2013.Therefore, attention should be paid to monitor the LRE in the hospital to decrease the prevalence of LRE infections.
关键词
乙酰胺类/恶唑烷酮类/肠球菌属/抗药性,细菌Key words
Acetamides/Oxazolidinones/Enterococcus/Drug resistance, bacterial引用本文复制引用
出版年
2015
NETL
NSTL
维普
万方数据