摘要
目的对碳青霉烯类抗生素耐药的肺炎克雷伯菌进行耐药分析及分子分型,为临床治疗提供病原学依据。方法收集定点医院2016年8月-2018年12月临床标本中分离的耐碳青霉烯类肺炎克雷伯菌,采用VITEK 2Compact进行细菌鉴定及药敏试验,标准纸片扩散法作为补充,碳青霉烯酶相关基因通过PCR扩增和产物测序确定,用脉冲场凝胶电泳(PFGE)进行分子分型并分析菌株的同源性。结果 71株肺炎克雷伯菌均耐15种药物以上,多重耐药率为100%。其中67株菌产超广谱β-内酰胺酶(94.4%),59株携带碳青霉烯酶blaKPC-2基因(80.3%)。经PFGE图谱分析分为49个PFGE型,其中以WZFK001型最多,占9.8%。结论产KPC-2型碳青霉烯酶是该院肺炎克雷伯菌碳青霉烯类抗生素耐药的主要原因,产超广谱β-内酰胺酶是β-内酰胺酶类抗生素耐药的主要机制。ICU等病房存在高度同源性的耐碳青霉烯肺炎克雷伯菌流行,应加强这些病房的院感管理,控制多重耐药菌的传播和流行。
Objective Antibiotic resistance analysis and molecular typing were used for Klebsiella pneumoniae with carbapenem resistance,to provide etiological basis for clinical treatment of Klebsiella pneumoniae.Methods Klebsiella pneumoniae isolated from clinical samples with carbapenem resistance was collected in designated hospitals from August,2016 to December,2018.VITEK 2 Compact was used to identify bacteria and detect antibiotic resistance.Also,diffusion tests were used to measure the antibiotic sensitivity as a supplement.Carbapenemase-related genes were identified by PCR and DNA-sequencing.Molecular typing was measured by pulsed-field gel electrophoresis( PFGE),and the homology of the strain was analyzed.Results A total of 71 strains of Klebsiella pneumoniae were significantly resistant to more than 15 antimicrobial agents,and multidrug resistance( MDR) reach to 100%.Among them,59 strains carried carbapenemases blaKPC-2 gene( 80.3%).49 PFGE types were analyzed by PFGE atlas,among which WZFK001 type accounted for 9.8%.Conclusion The production of KPC-2 carbapenems was the main cause of carbapenems antibiotic resistance in Klebsiella pneumoniae of the hospital,and the production of super-broad spectrum β-lactamase was the main mechanism of β-lactamase antibiotic resistance.There is a highly homologous epidemic of carbapene-resistant klebsiella pneumoniae in ICU and other wards,so the management of hospital admission in these wards should be strengthened to control the spread and prevalence of multi-drug resistant bacteria.
作者
章乐怡
楼辉煌
胡玉琴
沈丽珍
李毅
周海健
ZHANG Le-yi;LOU Hui-huang;HU Yu-qin;SHEN Li-zhen;LI Yi;ZHOU Hai-jian(Wenzhou Municipal Center for Disease Control and Prevention,Wenzhou,Zhejiang 325000,China;不详)
出处
《中国卫生检验杂志》
CAS
2020年第24期2976-2980,共5页
Chinese Journal of Health Laboratory Technology
基金
温州市弯曲菌的流行状况、分子分型及耐药研究(Y20180202)
艾滋病和病毒性肝炎等重大传染病防治(2017zx10303405-002)。
关键词
肺炎克雷伯菌
分子分型
多重耐药
碳青霉烯酶
Klebsiella pneumoniae
Molecular typing
Multi-drug resistance
Carbapenemases
