摘要
目的为新建医院的医院感染控制提供参考依据。方法回顾性分析2017—2020年苏州科技城医院微生物室分离的763株肺炎克雷伯菌临床分布及药敏试验结果;应用脉冲场凝胶电泳(PFGE)技术分析耐碳青霉烯类肺炎克雷伯菌(CRKP)的同源性,PCR技术检测其碳青霉烯酶基因;对产碳青霉烯酶的菌株进行质粒接合转移实验;对代表性菌株进行全基因组测序分析。结果该院肺炎克雷伯菌主要分离自痰液(50.98%)、尿液(30.80%)、血液(12.06%)、分泌物(7.73%)等;菌株主要来源于神经外科、呼吸内科、重症监护病区、肿瘤内科等科室;菌株对四环素、哌拉西林耐药率达30%,对喹诺酮类、阿莫西林/克拉维酸、哌拉西林/他唑巴坦、庆大霉素耐药率均在20%以下,对阿米卡星、碳青霉烯类耐药率在10%以下;PFGE结果显示CRKP有32个克隆型,A22、A26型为相对优势克隆型;PCR法检测出22株bla_(KPC)阳性,6株bla_(NDM)阳性,2株bla_(IMP)阳性,2株bla_(KPC)、bla_(NDM)双阳性;7株bla_(KPC)、2株bla_(NDM)阳性菌株接合转移成功;代表菌株全基因组测序结果显示该株菌为KPC-2、ST11型,未携带肺炎克雷伯菌常见的rmpA、rmpA2等毒力基因,携带少见的iutA、iroN毒力基因及pilW基因。结论该新建医院CRKP的检出率呈上升趋势,耐药基因型逐渐多样性,应予以高度关注。
Objective To provide a reference basis for the control of nosocomial infection in a newly-built hospital.Methods The clinical distribution and drug sensitivity test results of 763 strains of Klebsiella pneumoniae isolated from the Microbiology Room of Suzhou Science and Technology Town Hospital during 2017 and 2020 were analyzed retrospectively.The homology of carbapenem-resistant Klebsiella pneumoniae(CRKP)was analyzed by pulsed field gel electrophoresis(PFGE),and carbapenemase genes were detected by polymerase chain reaction(PCR).The carbapenemase-producing strains were preformed plasmid conjugation and transfer experiments,and the whole genome of representative strains was sequenced.Results Klebsiella pneumoniae was mainly isolated from sputum(50.98%),urine(30.80%),blood(12.06%)and secretion(7.73%),and these strains mainly came from departments of neurosurgery,respiratory medicine,intensive care unit(ICU)and oncology.Drug sensitivity test results showed that the resistance rates of tetracycline and piperacillin were about 30%,those of quinolones,amoxicillin/clavulanic acid,piperacillin/tazobactam and gentamicin less than 20%,and those of amikacin and carbapenems less than 10%.PFGE results showed that there were 32 clonal types of CRKP,and that A22 and A26 were relatively dominant.PCR results showed that twenty-two isolates carried bla_(KPC),six carried bla_(NDM),two carried bla_(IMP),and two carried bla_(KPC) and bla_(NDM).Seven strains with positive bla_(KPC) and two with positive bla_(NDM) were successfully transferred.The whole genome sequencing results of a representative strain showed that it was KPC-2 and ST11 type,did not carry the common virulence genes of Klebsiella pneumoniae,such as rmpA and rmpA2,and carried the rare virulence genes such as iutA and iroN and pilW gene.Conclusion The detection rate of CRKP in the newly-built hospital shows an upward trend,and the drug resistance genotypes are gradually diversified,which should be paid close attention to.
作者
王婷
杜鸿
程肖霞
邓春敏
赵晨
WANG Ting;DU Hong;CHENG Xiaoxia;DENG Chunmin;ZHAO Chen(Department of Clinical Laboratory,Suzhou Science and Technology Town Hospital,Suzhou 215153,Jiangsu;Department of Clinical Laboratory,the Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu,China)
出处
《临床检验杂志》
CAS
2022年第5期341-346,共6页
Chinese Journal of Clinical Laboratory Science
基金
苏州高新区医疗卫生科技计划项目(2019Q013)。
