摘要
目的分析近5年耐碳青霉烯类肺炎克雷伯菌的耐药特性及其携带碳青霉烯酶基因等分子流行病学特征,为有效控制院内感染提供依据。方法收集2012年1月—2016年12月苏州大学附属第二医院临床标本中分离的耐碳青霉烯类肺炎克雷伯菌,用最低抑菌浓度(minimal inhibitory concentration, MIC)法、KB法分析菌株对抗菌药物的敏感性,用改良碳青霉烯灭活试验检测产碳青霉烯酶表型,并通过聚合酶链反应(polymerase chain reaction, PCR)筛选blaKPC、blaNDM、blaIMP、blaVIM和blaOXA48碳青霉烯酶基因,通过脉冲场凝胶电泳(pulsed-field gel electrophoresis, PFGE)和多位点序列分型(multiple locus sequence typing, MLST)检测细菌的同源性和相关遗传性。统计分析相关患者临床资料。结果共分离到82株耐碳青霉烯类肺炎克雷伯菌,主要来源于呼吸道43株(52.44%),中段尿12株(14.63%),血液10株(12.20%),无菌体液8株(9.76%),分泌物8株(9.76%),导管1株(1.22%),对头孢菌素类和β-内酰胺类抗菌药物表现为高度耐药(85.4%～100%),碳青霉烯灭活试验阳性率为84.1%。PCR检测到71株细菌携带碳青霉烯酶基因,包括KPC阳性56株(78.87%)、NDM阳性10株(14.08%)、IMP阳性4株(5.64%)、VIM阳性1株(1.41%)。感染患者主要集中在重症监护室(ICU)病区(41株,50.00%)和神经外科(14株,17.07%)。2016年检出的32株中有23株(71.9%)PFGE呈高度同源性,且MLST分型均为ST11,其余7株为ST64型(21.9%),2株为ST23型(6.2%)。结论本院肺炎克雷伯菌主要分布于ICU,以呼吸道标本检出率最高,对碳青霉烯类耐受主要由于产KPC酶,需进一步加强临床耐药细菌的监测,为临床合理使用抗菌药物和严格执行消毒隔离措施提供参考依据。
Objective To analyze the molecular epidemiology such as the drug resistant properties and the carbapenemases-encoding gene of carbapenem-resistant Klebsiella pneumoniae （CRKP） in five years, and to provide the gist of effectively control nosocomial infections. Methods Collect all the CRKP strains isolated from clinical specimens in the Second Affiliated Hospital of Soochow University from 2012 to 2016. Antimicrobial susceptibility testing was conducted by the Kirby-Bauer and MIC method. The phenotypes of carbapenemase-producing strains were identified by a modified carbapenem inactivation method. Drug resistant genes including blar, pc, blaNDM blaIMP, blaviM and blaoxA48 were detected by Polymerase Chain Reaction （PCR）. Bacterial homology and clonal relatedness were identified by pulsed field gel electrophoresis （PFGE） and multiple locus sequence typing （MLST）. Collect and analyze all the clinical records of these patients. Results A total of 82 CRKP strains were isolated. There were 43 strains （52.44%） from respiratory, 12 strains （14.63%） from urine, 10 strains （12.20%） from blood, 8 strains （9.76%） from body fluid, 8 strains （9.76%） from secretion and 1 strain （1.22%） from catheter. All these strains were highly resistant to cephalosporin and β-lactam antibiotics （85.4%-100%）. The positive rate of the modified carbapenem inactivation method was 84.1%. PCR and DNA sequencing analysis confirmed that 71 strains produced carbapenemase genes, including 56 strains （78.87%） produced blaKPC, 10 strains （14.08%） produced blaNDM, 4 strains （5.64%） produced blaIMP, and 1 strain （1.41%） produced blaVIM. These patients distributed mainly in intensive care unit （ICU） （41 strains, 50.00%） and the neurosurgery department （14 strains, 17.07%）. In 2016, the PFGE results showed 23 stains （71.9%） had highly homology and the MLST results were STll type. Another 7 strains （21.9%） were ST64 and 2 strains （6.2%） were ST23. Conclusion Carbapenem-resis
作者
刘婷婷
杜鸿
周惠琴
谢小芳
郑毅
Liu Ting-ting;Du Hong;Zhou Hui-qin;Xie Xiao-fang;Zheng Yi(The Clinical Laboratory of the Seventh People＇s Hospital of Suzhou,Suzhou 215004;The Clinical Laboratory of the Second Affiliated Hospital of Soochow University,Suzhou 215004)
出处
《中国抗生素杂志》
CAS
CSCD
2018年第11期1436-1442,共7页
Chinese Journal of Antibiotics
基金
江苏省科技厅重点研发计划(No.BE2017654)
苏州市临床微生物学重点实验室项目(No.SZS201715)
