Abstract
目的 了解天津地区肠杆菌科临床株中质粒介导的喹诺酮类耐药基因qnrA、aac(6')-Ib-cr的分布并研究其耐药机制.方法 从天津地区8家三甲医院收集环丙沙星耐药(CPLX,MIC≥4μg/ml)的肠杆菌科菌株共116株,包括77株大肠埃希菌、24株阴沟肠杆菌、15株克雷伯菌属细菌.应用PCR方法筛查所有临床株的qnrA基因,并对大肠埃希菌进行aac(6')-Ib的检测;琼脂稀释法测菌株的药敏情况;DNA测序检测aac(6')-Ib-cr基因变异体;接合传递试验方法探讨细菌质粒介导的耐药性传递.结果 116株喹诺酮类耐药的肠杆菌科临床株中未发现qnrA基因阳性株;77株环丙沙星耐药的大肠埃希菌.15株检出aac(6')-Ib,其中对卡那霉素耐药10株、中敏4株、敏感1株;选出对卡那霉素耐药表型不同的6株菌的aac(6')-Ib扩增产物进行测序,结果表明5株菌在第223位(T→C或T→A)和454位(G→T)发生变异,均携带aac(6')-Ib-cr;6株测序菌株中4株接合传递成功,临床株对喹诺酮类和氨基糖甙类的耐药性部分传递给了受体株.结论 qnrA基因在天津地区116株肠杆菌科临床株中甚为罕见;首次在天津发现aac(6')-Ib-cr介导的喹诺酮类耐药。
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