Nghiên cứu kiểu hình kháng kháng sinh của một số vi khuẩn thường trú trong đường tiêu hóa người tình nguyện khỏe mạnh đến khám sức khỏe tại trung tâm y tế dự phòng huyện Hóc Môn trong năm 2015 / Dương Nhật Linh

khang cephalosporin the h� 3 chiJm 85,48 % trong t6ng s6 420 nguai khoe ml.lnh tham

gia nghien cfru nay.

i'u nhung chimg vi khutn khang thu6c tren, sau qua trinh sang I9c va xac dinh

chung toi thu duqc ket qua nhu sau:

+ Chung vi khufin sinh enzym ESBL: 261 chung E. coli (chi"8m 62,14 %), 53

chung Klebsiella spp. ( 12,62 % ), 3 chung Enterobacter spp ( chiSm �q 1 % ).

+ Chung vi khufin sinh enzym AmpC: 69 chung E. coli (chiSm 16,43 %), 41 chung

Klebsiella spp. (9,76 %),

+ Chung vi khufin sinh_enzym carbapenemase:-31 chung E.coli (chiSm 7,38%), 22

chung Klebsiella spp. (chiSm 5,24%), 18 chung Acinetobacter spp. (chiSm 4,29%) va 6

chung P.aeruginosa (chiSm 1,43 %).

- Tir cac kSt qua knao sat vS d�c diSm dan s6 cfing nhu d�c diSm kham chfra b�nh

,;·

Cua nh6m nguai tham gia nghien ClIU, chung toi nh�n thfiy vi�c SU' d1_mg khang sinh trong

vong 3 thart

g tru6c khi tham gi{ nghien CUU, cfing nhu SU'. d1_mg khang sinh khong dung 1

liSu hay bo liSu, h.r ,;, mua thu6c ho�c mua thu6c do SlJ tu vfin cua nhan vien ban thu6c tai

nha thu6c tu nhan dSu lam gia tang ty 1� nguai mang vi khuAn duang ru(H dS khang

khang sinh. Ben cl_lnh d6, ty 1� nguai nh�p vi�n trong vong 3 thang tru6c khi tham gia

nghien cuu cfing lam gia tang ty 1� nay.

--- -Cac chung·vi khufin khang thu6c cho thfiy cac chung vi khufin nay dSu la nhung

chung vi khufin da khang thu6c, c6 kha nang khang tir 2 lol_li khang sinh tr& len

5. San phftm:

- Chung vi khufin E.coli, Klebsiella spp., Acinetobacter spp., P.aeruginosa dS

khang khang sinh duqc phan l�p tir nhfrng nguai tinh nguy�n khoe ml_lnh.

- Dao tl_lO duqc 02 CU' nhan cong ngh� sinh h9c kh6a 2011.

6. Hi�u qua, phrrong thrrc chuy�n giao k�t qua nghien CU'U va kha nang ap dl}ng:

. .

Mau 12. Thong tin kit quii nghien cfru bdng tilng Anh

MINISTRY OF EDUCATION AND TRAINING

HO CHI MINH CITY OPEN UNIVERSITY

INFORMATION ON RESEARCH RESULTS

1. General information

Project Title: Research phenotypic antibiotic resistance of some bacteria

residence on gastrointestinal of healthy volunteers to a medical examination

_attheJ:�_reventive-Medicine_Center __ ofHoc_MonJ�r:ovince-in--2015--

- Project Code: T2015.1.180

- Coordinator: Duong Nhat Linh

Project Owner: Hp Chi Minh City Open University -

- Project time: July 2(fl2 -April 2016

2. Purpose of the Study ,-

Research phenotypic antibiotic resistance of some bacteria residence on gastrointestinal

of healthy volunteers to a medical examination at the Preventive Medicine Center of Hoc

Mon Province in 2015

3. Creation and innovation

Identify antibiotic resistance phenotypes of E. coli, Klebsiella spp., Acinetobacter

spp., P.aeruginosa isolated from healthy volunteers. From there, help give warnings and

measures, specific communication to help curb the spread of the lowest of antibiotic

resistant bacteria into the community and aims to protect the community.

4. Research results

From 420 stool samples collected from healthy people to visit at the Preventive

Medicine Center of Hoc Mon Province, we identified 359 stool samples generation 3rd

cephalosporin-resistant bacteria, synonymous with healthy people strong bearing

generation 3rd cephalo.sporin-resistant bacteria accounted 85,48% of 420 healthy people

participat_ed in this study.

. .

1.5.2. Vift Nam ............................................................................................... 44

CHlfllNG 2. VJT LI}JU VA PHUONG PHAP ................................................. .46

2.1. VJT Lli;;U ...................................... '. ...................................................... ; ...... 47

211 . . . D• 1a a•,: rem va 'th'• a1 gzan • ng h•A 1en ctrn , ...................................................... . 47

2.1.2. D<Ji tu()'ng nghien cuu .................................................................. ; ...... .47

2.1.3. Thilt bj, d1:1ng Cl:l, moi truimg ................................. � .......................... .47

. ··:�

, A tfU' "Ii.-,.

2.2. PHUONG PHAP NGHIEN C .............................. :· ............................... .48

2.2.1. B6 tri thi nghifm ................................................................................... 48

2.2.2. Quy trinh lciy mtiu va phiin lt;ip ........................................................... .49

2.2.3. -Quy trinh iljnh-danh ........................................................................... '..51

2.2.4. Ky thut;it khang sinh i18 bling phuang phap khuich tan khang sinh

trong thqch tit ilia giciy tdm khang sinh ........................................................ 56

2.2.5. Ky thflt;it xac ilfnh vi khulm iluang rU<Jrtiit ESBL. .............................. 58

2.2.6. Ky thu'i;t sang l9c vi khulm iluang ru9t tiit enzym AmpC ................... 59

2.2. 7. Ky thut;it xa� iljnh vi khudn tilt enzym carbapenemase ....................... 60

2.2.8. Xu ly st5 li¢u ...... ... ... ... ... ... ...... ... ... ... ... ....... ... ... ... ... ... ... ... ... ... ... 62

2.2.8. vdn iii y iluc ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ....... ...... ..... 62

CHUONG 3. KET QUA VA BI}JN LUJN.� ......................................................... 63

3.1. DJC TiNH MAU NGHIEN c(!u VA DJC DIEM KHAM CHUA Bi;;NH.64

3.1.1. Dijcctinhmtiu nghien cuu ..................................................................... 64

3.1.2. Di;ic ilidm kham chfta bfnh. .................................................................. 64

3.2. KET QUA PHAN LJP VA DJNH DANf[. ................................................... 65

3.2.1. Kit qua phiin-ft;ip ................... ,. .............................................................. 65

3.2.2. Kit qua iltnh danh ................................................................................ 67

3.3. X4C D/NH TY Li;; VI KHUAN E. COLL KLEBSIELLA SPP. SINH

ENZYM ESBL, AmpC, CARBAPENEMASE ...................................................... 68

3.3.1. Xac iljnh ty If E. coli, Klebsiella spp. sinh ESBL ............................... 68

3.3.2. Xac ilinh ty If E. coli, Klebsiella spp. sinh enzym AmpC .................... 73

3.3.3. Xac iljnh ty If E. coli, Klebsiella.spp. sinh carbapenemase ................ 77

iv

DANH MUC cAc TU VIET TAT

CDC: Center for Disease Control and Prevention

CFU: Colony Forming Unit (s6 dan vj khmin li.ic)

CLSI : Clinical and Laboratory Standards Institute

DNA: Deoxyribonucleic aicd

ESBL: Extended spectrum beta- lactamase

GARP: Global Antibiotic Resistance Partnership

MIC : Minimum Inhibitory.Concentration

RNA: Ribonucleic acid

VSV : Vi sinp v�t

..:-

PBP : Pencillin - blinding protein

P ABA: Parraminooenzoic acid

- .

vi

DANH MUC HINH ANH

Hinh 1.1 Ty !¢ ESBL tu cac tac nhlin gliy nhiim khulm 6 bimg theo khu VlfC tu niim

2002 ain niim 2011 . .......................... : .............................................. .......................... · 23

Hinh 1.2 Tyli ESBL tu cac tac nhlin gliy nhiim trung iluang tiit niiu theo khu VlfC

. tu niim 2009 ain niim 2011 ........................................................... :: ........................... 24

\�

"Ii,.

Hinh 1.3 Hinh anh nhu9m gram vi khudn Escherichia coli (Ngu6n: Internet) ........ 30

Hinh 1.5 Hinh thai khudn lqc Klebsiella ,spp. tren moi truang Maconkey.

(Ngu6n: Internet) ........................................................................................................ 34

Hinh 1.6 Hinh anh nhu9m gram v{khudn P.aeruginosa (Ngu6Y1:_

: Internet) ............. 39

Hinh 1.5 Hinh thai khudn lqc P. aeruginosa tren moi truang MacConkey (Ngu6n:

Internet) ....................................................................... :7: .............................................. 40 ·- .

-:·

Hinh 2.1 Thu tlf ma khang sinh ...... �·· ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..... 61

.. ,,.

Hinh 2.2 Phuang phap Hodge test biin il6i ...... .......... ... ... ... ... ... ... ... ... ... ... ... .... 62

'•

Hinh 3.1 Phan l(lp mJu phan tren moi truang tren ChromID ESBL (A) va m6i

truang ChromID C(J ban (kh6ng khang sinh) (BJ .... ············ ................. ····················· 66

Hinh 3.2 Hinh thai' khudn lqc cua cac vi khudn phlin l

(lp a mdu phlin tren m6i

truang ChromID ESBL ............................................................................................... 67

Hinh 3.3 Kit qua khang sinh il6 cua E.coli 57e sinh enzym ESBL, AmpC va

carbapenemase ................................................... !' •••••..•••.•.••••.•••••••....•.••••..••.••..... , •••••.. 69

ffinh 3.4 Kit qua khang sinh il6 cua Klebsiella spp. 12k sinh enzym ESBL, AmpC va

carbapenemase ........................................................................................................... 7 4

ffinh 3.5 Kit qua khang sinh il6 cua E.coli 29e sinh enzym AmpC va

carbapenemase ........................................................................................................... 77

ffinh 3.6 Kit qua khang sinh il6 cua P.aeruginosa 86p va Acinetobacter spp. 26a

sinh.enzym carbapenemase ................................ •........................................................ 80

viii