摘要
目的分析碳青霉烯类肺炎克雷伯菌耐药基因分布特征及其机制。方法收集青岛大学附属威海市中心医院2021年1-12月临床标本分离得到的耐碳青霉烯类肺炎克雷伯菌58株,通过改良Hodge试验和改良碳青霉烯灭活试验确认表型,聚合酶链式反应(PCR)扩增后纯化测序,脉冲场凝胶电泳法(PFGE)聚类分析和多位点序列分型(MLST)分析其分子流行病学特征。结果碳青霉烯类耐药肺炎克雷伯菌(CRKP)对阿米卡星敏感率为51.7%,对环丙沙星、左旋氧氟沙星、复方磺胺甲噁唑、哌拉西林/他唑巴坦等抗生素均具有较高耐药率(> 60%),对头孢唑林、头孢他啶、头孢替坦及头孢吡肟耐药率为100.0%。58株菌株中46株(79.3%)改良Hodge试验阳性,31株(53.5%)改良碳青霉烯灭活试验阳性。PCR扩增及基因测序显示,42株(72.4%)菌株主要携带KPC-2基因,12株(20.7%)菌株携带IMP-4基因,4株(6.9%)菌株携带NDM-1基因。且携带IMP-4基因的12株菌株均携带KPC-2基因,表现为改良Hodge试验和改良碳青霉烯灭活试验双阳性。PFGE聚类分析和MLST分析显示,产KPC-2型菌株主要为ST11-B型和ST395-A型,产KPC-2型和IMP-4型菌株主要为ST345-M型和ST11-B型,产NDM-1型菌株为ST263-F型和ST15-C型。结论 CRKP耐药现象严重,菌株中存在多种碳青霉烯酶,多携带KPC-2及IMP-4基因。
Objectives To investigate the distribution characteristics and mechanism of drug-resistant genes in carbapenem-resistant Klebsiella pneumoniae.Methods A total of 58 strains of carbapenem-resistant Klebsiella pneumoniae isolated from clinical specimens at Weihai Central Hospital,Qingdao University,from January to December 2021 were collected.Their phenotypes were confirmed by modified Hodge test and modified carbapenem inactivation test.Polymerase chain reaction was used for amplification.Pulsed field gel electrophoresis clustering and multilocus sequence typing were performed to characterize the molecular epidemiology of the strains.Results Carbapenem-resistant Klebsiella pneumoniae had a sensitivity rate of 51.7%to amikacin,a high(>60%)resistance rate to antibiotics such as ciprofloxacin,levofloxacin,compound sulfamethoxazole,piperacillin/tazobactam,and a 100.0%resistance to cefazolin,ceftazidime,cefotetan,and cefepime.The modified Hodge test was positive in 46(79.3%)of the 58 strains,and the modified carbapenem inactivation test was positive in 31 strains(53.5%).Polymerase chain reaction amplification and gene sequencing showed that 42 strains(72.41%)carried mainly the KPC-2 gene,12 strains(20.7%)carried the IMP-4 gene,and 4 strains(6.9%)carried the NDM-1 gene.The 12 strains carrying the IMP-4 gene all carried the KPC-2 gene and were double positive for the modified Hodge test and the modified carbapenem inactivation test.Pulsed field gel electrophoresis clustering and multilocus sequence typing analysis showed that the KPC-2 producing strains were mainly ST11-B and ST395-A,the KPC-2-and IMP-4-producing strains were mainly ST345-M and ST11-B,and NDM-1-producing strains were ST263-F and ST15-C.Conclusion Carbapenem-resistant Klebsiella pneumoniae is highly drug-resistant and carries a variety of carbapenemases,including the KPC-2 and IMP-4 genes.
作者
赛海芳
荣伟
Sai Haifang;Rong Wei(Department of Infection Management,Weihai Central Hospital,Qingdao University,Weihai 264400,Shandong Province,China;Department of Anesthesiology,Weihai Central Hospital,Qingdao University,Weihai 264400,Shandong Province,China)
出处
《中国基层医药》
CAS
2023年第12期1818-1822,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
肺炎克雷伯菌
抗生素类
抗药性
细菌
统计学分布
耐药机制
Klebsiella pneumoniae
Antibiotics
Drug resistance,bacteria
Statistical distributions
Drug resistance mechanism
