摘要
目的:通过对耐碳青霉烯类肺炎克雷伯杆菌(CRKP)的碳青霉烯酶表型的筛查及耐药基因检测,明确青岛市区该细菌耐药基因的分布及构成,为临床上合理应用抗菌药物治疗提供依据。方法:收集2016年10月至2019年9月青岛市区5家三甲医院临床分离出的非重复CRKP共54株,采用琼脂稀释法或纸片扩散法(K-B法)进行常用抗菌药物的药敏试验;应用改良Hodge试验进行碳青霉烯酶表型筛查;采用聚合酶链反应(PCR)扩增blaKPC-2、blaNDM-1、blaOXA-48、blaIMP、blaVIM目的基因,扩增产物进行琼脂糖凝胶电泳。结果:药敏试验显示,CRKP对阿米卡星耐药率最低(35.2%),其次为复方新诺明(53.7%)、庆大霉素(55.6%)、左氧氟沙星(75.9%)、亚胺培南/西司他丁(88.9%),哌拉西林/他唑巴坦、美罗培南、头孢噻肟、头孢哌酮/舒巴坦钠的耐药率均高于90%。改良Hodge试验阳性菌株有43株(阳性率为79.63%),阴性菌株为11株。PCR耐药基因检测共检出带有碳青霉烯酶耐药基因的菌株40株,目的耐药基因检出率为74.07%。其中35株携带KPC-2基因,7株携带OXA-48基因,4株携带NDM-1基因,1株携带IMP基因,其中携带有OXA-48基因的菌株均同时携带KPC-2基因,未检测出携带VIM基因的菌株,剩余14株未检测出目标碳青霉烯酶基因。结论:青岛市区5家医院CRKP携带的产碳青霉烯酶基因主要为KPC-2,其次为OXA-48及NDM-1。
Objective To clarify the distribution and composition of drug-resistant genes of carbapenem-resistant Klebsiella pneumoniae(CRKP)in Qingdao City and to provide rationale for clinical application of antibacterial treatment by screening for carbapenemase phenotype and detecting resistance genes of CRKP.Methods Fifty-four clinically isolated non-repeating CRKP from five Third Grade&Class A Hospitals in Qingdao City from October 2016 to September 2019 were collected.Kirby-Bauer method was used for drug sensitivity tests of commonly used antibacterial drugs;modified Hodge test was used for carbapenemase phenotypic screening;and polymerase chain reaction(PCR)was used to amplify blaKPC-2,blaNDM-1,blaOXA-48,blaIMP,blaVIM target genes.The amplified products were subjected to agarose gel electrophoresis.Results Drug susceptibility tests showed that CRKP had the lowest resistance rate to amikacin(35.2%),followed by compound sinomine(53.7%),gentamicin(55.6%),levofloxacin(75.9%),and imipenem-cilastatin(88.9%);piperacillin-tazobactam,meropenem,cefotaxime,and cefoperazone-sulbactam were all higher than 90%.There were 43 positive strains in the modified Hodge test(the positive rate was 79.63%)and 11 negative strains.A total of 40 strains with carbapenemase resistance were detected by PCR resistance gene detection.The detection rate of target drug-resistant genes was 74.07%.Among them,35 strains carry the KPC-2 gene,7 strains carry the OXA-48 gene,4 strains carry the NDM-1 gene,and 1 strain carries the IMP gene.All strains carrying the OXA-48 gene also carried the KPC-2 gene,which was not detected.Strains carrying the VIM gene were identified,and the remaining 14 strains did not detect the target carbapenem gene.Conclusion The carbapenem-producing genes carried by CRKP in five hospitals in Qingdao City are mainly KPC-2,followed by OXA-48 and NDM-1.
作者
安翔宇
谢伟峰
郑旭
赵蕾
吴义娟
曲彦
An Xiangyu;Xie Weifeng;Zheng Xu;Zhao Lei;Wu Yijuan;Qu Yan(Department of Intense Care Unit,Affiliated Qingdao Municipal Hospital of Qingdao University,Qingdao 266071,Shandong,China;Department of Laboratory Medicine,Affiliated Qingdao Municipal Hospital of Qingdao University,Qingdao 266071,Shandong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第2期145-149,共5页
Chinese Critical Care Medicine
基金
山东省自然科学基金(ZR2013HM109)
山东省青岛市医药卫生重点学科建设项目(2017-3)
山东省青岛市医药卫生优秀人才培养项目(2017-4)。
