摘要
目的探究血流感染碳青霉烯类耐药肺炎克雷伯菌(CRKP)的耐药性、耐药机制及同源性,以指导临床合理使用抗菌药物。方法收集某院2015-2017年临床分离自血液标本的非重复性CRKP,拉丝试验筛查高毒力肺炎克雷伯菌。改良碳青霉烯灭活法(mCIM)检测碳青霉烯酶表型,PCR法检测血清型基因(K1、K2、K20、K54等)及碳青霉烯酶基因(blaKPC、blaIMP、blaVIM、blaNDM、blaOXA-48等),rep-PCR分析同源性。结果共收集到46株CRKP,主要来源于ICU(43.5%)。CRKP除对磺胺甲噁唑/甲氧苄啶和替加环素有较高的敏感性外,对其余抗菌药物的耐药率均大于60.0%。mCIM试验阳性率为93.5%。blaKPC、blaIMP、blaNDM、blaVIM基因阳性,检出率依次为65.2%、13.0%、10.9%、4.4%。1株同时携带blaKPC、blaIMP,1株同时携带blaKPC、blaVIM,1株同时携带blaIMP、blaNDM,1株同时携带blaIMP、blaVIM。4种血清型基因被检出,K1、K2、K20、K54的检出率分别为4.4%、4.4%、4.4%、2.2%。rep-PCR结果显示46株CRKP分为A^F 6个型,以A型为主(80.4%),主要分布于ICU。值得注意的是,其中1株CRKP被鉴定为碳青霉烯类耐药高毒力肺炎克雷伯菌(carbapenem-resistant hypervirulent K.pneumoniae, CR-hvKP),血清型基因为K2。结论医院血液分离CRKP的耐药性已十分严重,与其携带blaKPC、blaIMP、blaNDM密切相关,且可能存在克隆性传播。同时,临床已分离出CR-hvKP,应该引起高度重视。
OBJECTIVE To explore the drug resistance,drug resistance mechanisms and homology of carbapenem-resistant Klebsiella pneumoniae(CRKP)causing bloodstream infection so as to provide guidance for reasonable use of antibiotics.METHODS Non-repetitive CRKP strains that were isolated from blood specimens from 2015 to 2017 were collected,the string test was conducted to identify hypervirulent Klebsiella pneumoniae,the phenotypes of carbapenemase were detected by using the modified carbapenem inactivation method(mCIM),the serotype genes(K1,K2,K20,K54,etc.)and carbapenemase genes(blaKPC,blaIMP,blaVIM,blaNDM,blaOXA-48,etc.)were detected by means of PCR,and the homology of the CRKP strains was analyzed through repeated sequence PCR(rep-PCR).RESULTS A total of 46 strains of CRKP were collected,43.5%of which were isolated from the ICU.The CRKP strains were highly susceptible to trimethoprim-sulfamethoxazole and tigecycline,while the drug resistance rates to other antibiotics were more than 60.0%.The positive rate of mCIM test was 93.5%.The positive rates of detection of blaKPC,blaIMP,blaNDM,and blaVIM were 65.2%,13.0%,10.9%and 4.4%,respectively.One strain co-carried both blaKPC and blaIMP,one strain co-carried both blaKPC and blaVIM,one strain co-carried both blaIMP and blaNDM,and one strain co-carried both blaIMP and blaVIM.Four serotype genes were detected positive,and the detection rates of K1,K2,K20,and K54 were 4.4%,4.4%,4.4%and 2.2%,respectively.The results of rep-PCR showed that 46 strains of CRKP strains were divided into 6 types of A-F,type A(80.4%)was dominant and prevalent in the ICU.It was worth noting that one of the strains was eventually identified as carbapenem-resistant hypervirulent K.pneumoniae(CR-hvKP),with the serotype gene K2.CONCLUSION The CRKP strains that are isolated from the blood specimens have been highly drug-resistant,which is closely associated with the carrying with blaKPC,blaIMP and blaNDM,and worse more,and there might be clonal propagation.The CR-hvKP strains have been emerged,which should be attached great importance to.
作者
李军
黄紫嫣
谭媛
陶晓燕
胡咏梅
王海晨
刘文恩
邹明祥
LI Jun;HUANG Zi-yan;TAN Yuan;TAO Xiao-yan;HU Yong-mei;WANG Hai-chen;LIU Wen-en;ZOU Ming-xiang(Xiangya Hospital,Central South University,Changsha,Hunan 410008,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第17期2561-2565,2593,共6页
Chinese Journal of Nosocomiology
基金
国家自然科学基金青年科学基金资助项目(81702068)
湖南省自然科学基金资助项目(2017JJ3478)
中南大学大学生创新类资助项目(ZY20171022)
关键词
血流感染
肺炎克雷伯菌
碳青霉烯类耐药
耐药机制
同源性
Bloodstream infection
Klebsiella pneumoniae
Carbapenem resistance
Drug resistance mechanism
Homology
作者简介
通信作者:邹明祥,E-mail:zoumingxiang@126.com
