耐碳青霉烯类肺炎克雷伯菌的耐药机制与分子流行病学特征
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赵书平

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R181.3+2R378.99+6

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山东省自然科学基金(ZR2016HL44)


Antimicrobial resistance mechanism and molecular epidemiological characteristics of carbapenemresistant Klebsiella pneumoniae
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    摘要:

    目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)的碳青霉烯酶基因携带情况及分子流行病学特点,为医院感染控制和临床治疗提供实验室依据。方法收集山东省泰安市中心医院2014年1—11月临床分离的CRKP 13株,采用WalkAway 96 PLUS型全自动细菌分析仪进行细菌鉴定和药敏试验;改良Hodge试验及EDTA 协同试验进行碳青霉烯酶表型的确认;采用多聚酶链反应(PCR)方法扩增相关碳青霉烯类耐药基因(blaKPC、blaIMP、blaVIM、blaGIM及blaNDM1)并测序;采用脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)调查菌株的克隆相关性并进行流行病学比较。结果13株CRKP主要来源于痰(7株,53.85%)及尿(4株,30.77%),对复方磺胺甲口恶唑、四环素的耐药率较低(均<40%),对其他抗菌药物(除阿米卡星)的耐药率均>70%,对碳青霉烯类药物的耐药率均为100%;13株细菌改良Hodge试验均为阳性,5株细菌EDTA协同试验阳性;经PCR测序确认,碳青霉烯酶基因中,blaKPC基因最常见(13/13),其次为blaNDM1基因(5/13),未发现其基因blaIMP、blaVIM和blaGIM;PFGE聚类结果显示,13株肺炎克雷伯菌被分为5型,主要为C型(9/13),且均属于ST11,其他分别为ST37、ST626、ST628和ST668型。结论碳青霉烯酶基因blaKPC与blaNDM1是引起该院肺炎克雷伯菌对碳青霉烯类抗生素耐药的主要原因, ST11是主要的克隆类型,医院需尽快强化医院感染预防控制措施。

    Abstract:

    ObjectiveTo investigate carbapenemase genes and molecular epidemiological characteristics of carbapenemresistant Klebsiella pneumoniae(CRKP), so as to provide laboratory basis for healthcareassociated infection(HAI) control and clinical treatment. Methods13 strains of CRKP isolated from Taian City Central Hospital between January and November 2014 were collected, bacterial identification and antimicrobial susceptibility testing were performed by WalkAway 96 PLUS automatic bacterial analyzer; carbapenemase phenotypes were confirmed by modified Hodge test and EDTAdisk synergy test; carbapenem resistance genes (blaKPC, blaIMP, blaVIM, blaGIM, and blaNDM1) were amplified by polymerase chain reaction (PCR), then sequenced; clone correlation of strains was investigated by pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST), epidemiology comparison was performed. Results13 strains of CRKP were mainly isolated from sputum (n=7, 53.85%) and urine (n=4, 30.77%), resistance rates to compound sulfamethoxazole and tetracycline were all low (all <40%), to the other antimicrobial agents (except amikacin) were all>70%, resistance rates to carbapenems were all 100%; 13 strains were all positive for modified Hodge test, 5 strains were positive for EDTAdisk synergy test; sequencing of PCR confirmed that blaKPC gene was most common among carbapenemase genes (13/13), followed by blaNDM1 gene (5/13), while blaIMP, blaVIM, and blaGIM gene were not found; clustering analysis of PFGE showed that 13 strains of Klebsiella pneumoniae were divided into 5 types, mainly type C (9/13), all belonged to ST11, others were ST37, ST626, ST628, and ST668 respectively. ConclusionCarbapenemase genes blaKPC and blaNDM1 are the main causes of the resistance of Klebsiella pneumoniae to carbapenems in this hospital, ST11 is the main clone type, hospital should strengthen the prevention and control of HAI as soon as possible.

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张志军,鹿麟,牛法霞,等.耐碳青霉烯类肺炎克雷伯菌的耐药机制与分子流行病学特征[J]. 中国感染控制杂志,2018,17(9):759-763. DOI:10.3969/j. issn.1671-9638.2018.09.002.
ZHANG Zhijun, LU Lin, NIU Faxia, et al. Antimicrobial resistance mechanism and molecular epidemiological characteristics of carbapenemresistant Klebsiella pneumoniae[J]. Chin J Infect Control, 2018,17(9):759-763. DOI:10.3969/j. issn.1671-9638.2018.09.002.

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  • 收稿日期:2017-12-30
  • 最后修改日期:2018-02-09
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  • 在线发布日期: 2018-09-28
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