摘要
目的了解产新德里金属-β-内酰胺酶(NDM)型碳青霉烯酶肺炎克雷伯菌(CRKP)分离株的分子流行病学特点。方法收集2013年9月至2016年3月住院患儿的非重复CRKP;采用PCR方法扩增NDM型碳青霉烯酶基因,并对阳性产物进行DNA测序;对产NDM酶菌株进行脉冲场凝胶电泳(PFGE),并利用BioNumerics软件进行分型;比较不同型别菌株患儿的临床特征。结果从93株CRKP中检出42株产NDM酶,其中23株产NDM-1酶,19株产NDM-5酶。产NDM酶CRKP分为14个PFGE型别(A型~N型),其中A型、M型和N型为优势型别,占菌株总数69%(29/42),其余11型为非优势型别,占菌株总数31%(13/42)。A型菌株(24%,10/42)均产NDM-1酶,M型菌株(17%,7/42)以产NDM-5酶为主,N型菌株(29%,12/42)均产NDM-5酶,其余11个型别菌株(31%,13/42)以产NDM-1酶为主。优势型别组菌株主要在儿科ICU流行,而非优势型别组菌株在儿科各病区散发分布。优势型别组患儿在入院48小时后发生感染率、留置引流管比例和ICU住院时间均高于非优势型别组患儿,差异有统计学意义(P<0.05);两组患儿的年龄、性别、抗生素使用和预后等的差异均无统计学意义(P>0.05)。结论住院患儿产NDM酶CRKP的碳青霉烯酶类型以NDM-1和NDM-5多见,A型、M型和N型为PFGE优势型别,优势型别在儿科ICU存在小范围播散。
Objective To explore the molecular epidemiologic characteristics of New Delhi metal-β-lactamase(NDM)carbapenemase producing Klebsiella pneumoniae strains.Methods From September 2013 and March 2016,the carbapenemresistant Klebsiella pneumoniae(CRKP)were collected from hospitalized children.The NDM carbapenem gene was identified by PCR and DNA sequencing.The NDM carbapenemase producing CRKP strains were typed using pulsed-field gel electrophoresis(PFGE)and BioNumerics software.The clinical characteristics of children with different strains were compared.Results In 93 CRKP strains,a total of 42 strains of NDM carbapenemase producing CRKP were detected,including 23 NDM-1 and 19 NDM-5 carbapenemase producing strains.The NDM carbapenemase producing CRKP strains were divided into 14 types(type-A^N).Type-A,type-M and type-N were the dominant types,accounting for 69%(29/42).The other 11 types were non-dominant types,accounting for 31%(13/42).Type A strains(24%,10/42)all produced NDM-1 carbapenemase,and type M strains(17%,7/42)mainly produced NDM-5 carbapenemase.Type N strains(29%,12/42)all produced NDM-5 carbapenemase,and the other 11 strains(31%,13/42)mainly produced NDM-1 carbapenemase.The dominant strains were prevalent in pediatric ICU,while non-dominant strains were distributed in all pediatric wards.Infection rate after 48 h since admission,proportion of indwelling drainage tube and duration of ICU stay in patients infected with dominant types were higher than those in patients infected with non-dominant types,and the differences were statistically significant(P<0.05).There were no statistically significant differences in age,gender,antibiotic usage,prognosis between the two groups(P>0.05).Conclusions The NDM carbapenemase producing CRKP isolated from hospitalized children mainly produced NDM-1 or NDM-5 carbapenemase.Type A,M and N strains were three dominant PFGE types,which spread in a small scale in pediatric ICU wards.
作者
李媛睿
刘婧娴
俞静
朱威南
刘瑛
LI Yuanrui;LIU Jingxian;YU Jing;ZHU Weinan;LIU Ying(Clinical Microbiology Laboratory,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2018年第9期689-693,共5页
Journal of Clinical Pediatrics
