摘要
目的通过全基因组测序技术(whole genome sequencing,WGS)分析某三甲医院耐碳青霉烯肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumonia,CRKP)的耐药基因分布及与耐药表型的关系,为临床治疗和防控提供参考。方法收集并鉴定临床分离非重复CRKP 28株。采用VITEK-2 compact全自动微生物鉴定药敏分析仪进行鉴定和药敏试验,使用全基因组测序技术进行测序。结果共检出47种耐药基因。其中碳青霉烯类耐药基因3种,主要为blaKPC-2基因(25株,89.29%),其次为blaNDM-5基因(2株,7.14%)和blaOXA-48基因(1株,3.57%);超广谱β-内酰胺酶(exterded spectrumβ-lactamases,ESBLs)耐药基因8种,主要为blaTEM-1、blaSHV-28、blaCTX-M-15和blaOXA-33,检出率分别为89.29%、75.00%、75.00%和67.86%;氨基糖苷类耐药基因10种,以AAC(6')-Ib-cr和AAC(3)-IIa为主,检出率分别为71.43%和67.86%;喹诺酮类耐药基因4种,主要为oqxA和AAC(6')-Ib-cr,检出率分别为85.71%和71.43%,其中20株CRKP同时携带oqxA和AAC(6')-Ib-cr;磷霉素耐药基因1种,为FosA6,检出率为100%;磺胺类耐药基因3种,主要为sul 2和sul 1,检出率分别为21.43%和17.86%。28株CRKP的药敏结果显示,对碳青霉烯类抗菌药物、头孢菌素类、喹诺酮类和β-内酰胺类/β-内酰胺酶抑制剂合剂的耐药率均为100%;对阿米卡星的耐药率为14.29%,未检出替加环素耐药株。28株CRKP对所测β内酰胺类抗菌药物的耐药表型与耐药基因型完全一致。结论该院分离的CRKP同时携带多种抗菌药物的耐药基因,呈现泛耐药表型,其耐药表型和耐药基因型有很高的一致性。
Objective To analyze the distribution of resistance genes of carbapenem-resistant Klebsiella pneumoniae(CRKP)in our hospital and the relationship between resistance genes and phenotypes.The results will provide reference for clinical treatment,prevention and control.Method The non-duplicated CRKP28 strains isolated from clinical specimens were collected.The bacteria were identified and tested for drug sensitivity by VITEK-2 compact automatic microorganism identification and drug susceptibility analyzer.The whole genome sequencing technology was used for sequencing.Results 47 drug resistance genes were detected.There were 3 carbapenem resistance genes,mainly blaKPC-2 gene(25 strains,89.29%),blaNDM-5 gene(2 strains,7.14%)and blaOXA-48 gene(1 strain,3.57%);Extended-spectrumβ-lactamases(ESBLs)resistance genes were mainly blaTEM-1,blaSHV-28,blaCTX-M-15 and blaOXA-33,and the detection rates were 89.29%,75.00%,75.00%and 67.86%,respectively.AAC(6')-Ib-cr and AAC(3)-IIa were the main aminoglycoside resistance genes,the detection rates were 71.43%and 67.86%,respectively;oqxA and AAC(6')-Ib-cr were the main quinolone resistance genes,and the positive rates were 85.71%and 71.43%,respectively.Among them,20 CRKP strains carried both oqxA and AAC(6')-Ib-cr;FosA6 was the resistant gene to fosfomycin,and the positive rate was 100%.There were three sulfonamides resistance genes,mainly sul 2 and sul 1,and the detection rates were 21.43%and 17.86%,respectively.The drug resistance of 28 strains of CRKP to carbapenems,cephalosporins,quinolones andβ-lactams/β-lactamase inhibitor mixture was 100%;The resistant rate to amikacin was 14.29%,and no resistant strain to tigecycline was found.The resistance phenotype and genotypes of 28 strains of CRKP were completely consistent with the testedβ-lactam antibiotics.Conclusion CRKP isolates from our hospital carry multiple antimicrobial resistance genes,showing a pan-resistant phenotype.The resistance phenotype and resistance genotype have a high consistency.
作者
谢强
谢瑞玉
徐添天
XIE Qiang;XIE Rui-yu;XU Tian-tian(Department of Laboratory Medicine,Chuzhou First Hospital,Chuzhou 239001)
出处
《临床输血与检验》
CAS
2021年第4期501-506,共6页
Journal of Clinical Transfusion and Laboratory Medicine
关键词
肺炎克雷伯菌
超广谱Β内酰胺酶
耐药基因
全基因组测序
Klebsiella pneumonia
Extended-spectrum
β-lactamases
Resistance gene
Whole genome sequencing
