摘要
目的调查我国2009至2016年耐碳青霉烯类肺炎克雷伯菌的药物敏感性及分子流行状况。方法挑选2009至2016年中国细菌耐药监测研究项目收集的肺炎克雷伯菌中厄他培南耐药菌株为碳青霉烯类耐药肺炎克雷伯菌(CRKP),采用美国临床实验室标准协会(CLSI)推荐的平皿二倍稀释法检测14种抗菌药物对其最低抑菌浓度(MIC)。改良碳青霉烯灭活试验(mCIM)和EDTA改良碳青霉烯灭活试验(eCIM)法检测CRKP中碳青霉烯酶;PCR扩增检测碳青霉烯酶基因。多位点序列分析(MLST)和脉冲场凝胶电泳(PFGE)检测不同菌株的同源性。结果在2502株肺炎克雷伯细菌中筛选出193株CRKP。193株CRKP除对多黏菌素E(4.0%)、替加环素(7.3%)、磷霉素(25.4%)、阿米卡星(38.3%)和米诺环素(38.9%)的耐药率低于40%,对其余9种抗菌药物耐药率均高于65%。其中143株(74.1%)检测出碳青霉烯基因,最多的分别是blaKPC-288株(45.6%)和blaNDM-140株(20.7%)。126株产KPC-2和NDM-1型碳青霉烯酶的肺炎克雷伯菌株包含33个ST型,以ST11(59.5%)为主。所有ST11菌株均产KPC-2型碳青霉烯酶。受检菌株经PFGE指纹图谱分析共得到111种克隆,其中12种含有2株或以上同克隆菌株。结论2009至2016年肺炎克雷伯菌对碳青霉烯类的耐药率不断上升,临床医护人员应采取合理措施加强对CRKP的耐药性监测,控制其在全国范围内的传播。
Objective The study aimed to investigate the drug sensitivity and molecular epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae in China from 2009 to 2016.Methods For Klebsiella pneumoniae collected from China Antimicrobial Resistance Surveillance Trial(CARST)from 2009 to 2016,those resist to ertapenem were screened out as the carbapenem-resistant Klebsiella pneumoniae(CRKP).Antibiotic susceptibilities of 14 antibacterial agents to the bacteria were assessed by minimum inhibitory concentration(MIC)using two-fold agar dilution test which was recommended by the Clinical and Laboratory Standard Institute(CLSI).Carbapenemases were filtered out by the modified carbapenem inactivation method(mCIM)and EDTA-modified carbapenem inactivation method(eCIM)test,PCR was used to screen for the presence of carbapenemase genes or not.Pulsed-field gel electrophoresis(PFGE)and multilocus sequence typing(MLST)were used to analyze the homology of these isolates.Results A total of 193 CRKP were screened out in the 2502 Klebsiella pneumoniae isolates.The resistance rates of 193 CRKP isolates to colistinE(4.0%),tigecycline(7.2%),fosfomycin(25.4%)and amikacin(38.3%)were less than 40%.However,the resistance rates to the other 9 antimicrobial agents were higher than 65%.There were 143 carbapenemase gene detected in 193 CRKP,of which blaKPC-288(45.6%)and blaNDM-140(20.7%)were the most common.In the 126 isolates of Klebsiella pneumoniae producing KPC-2 and NDM-1 carbapenemases,a total of 33 ST-types were detected,mainly was ST11(59.5%).All ST11 strains produce KPC-2 carbapenemase.A total of 111 clones were obtained from PFGE fingerprints,there were 12 clones in which the same clone strains were equal or greater than 2.Conclusion The resistance rate of Klebsiella pneumoniae to carbapenems has been rising from 2009 to 2016,and clinicians should take reasonable measures to strengthen the monitoring of resistance to CRKP and control its spread across the country.
作者
张凡
李耘
甘露
Zhang Fan;Li Yun;Gan Lu(Institute of Clinical Pharmacology,Peking University First Hospital,Beijing 100034,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2019年第11期949-954,共6页
Chinese Journal of Laboratory Medicine
关键词
肺炎克雷伯菌
卡巴配能类
抗药性
细菌
微生物敏感性试验
电泳
凝胶
脉冲场
多位点测序分型
Klebsiella pneumoniae
Carbapenems
Drug resistance
bacterial
Microbial sensitivity tests
Electrophoresis
gel
pulsed-field
Multilocus sequence typing
