浙江省丽水地区发现1株泛耐药产KPC-2碳青霉烯酶的肺炎克雷伯菌  

Detection of a strain of extensively drug resistant Klebsiella pneumoniae producing carbapenemase KPC-2 in Lishui,Zhejiang province

作　　者：黄金伟[1] 黄建胜[1] 陈海泉[1] 李国雄[1] 余方友[2] 任建敏[1] 

机构地区：[1]丽水市中心医院检验科,浙江丽水323000 [2]温州医学院附属第一医院实验诊断中心

出　　处：《疾病监测》2011年第1期58-60,共3页Disease Surveillance

摘　　要：目的研究泛耐药肺炎克雷伯菌的相关耐药机制及初步探讨治疗对策。方法细菌鉴定采用Vitek-compact细菌鉴定系统,药敏实验采用K-B法,通过产碳青霉烯酶确证试验(Hodge实验)及聚合酶链反应(PCR)检测KPC-2基因,并进行序列测定。同时调查患者感染的诊疗情况。结果常规药敏实验显示除多粘菌素、米诺环素外全部耐药;增加磷霉素K-B法药敏实验显示抑菌环直径为20mm,K-B法协同药敏实验显示多粘菌素、米诺环素、磷霉素、亚胺培南等均无协同抗菌活性;Hodge实验阳性,PCR检测到KPC-2基因,序列与GenBank AF297554序列一致。患者经拔除导尿管,入隔离病房,加强支持治疗后,1个月内未检查到泛耐药肺炎克雷伯菌。结论加强泛耐药肺炎克雷伯菌监测,提高对泛耐药菌的认识有助于感染疾病的治疗和预防。Objective To study the extensively drug resistant mechanisms of Klebsiella pneumoniae and discuss the clinical treatment strategies. Methods The isolate was identified by Vitek-compact system,the drug susceptibility test was conducted by K-B method,and KPC-2 gene was detected by Hodge test and polymerase chain reaction （PCR）,then sequenced,and the treatment of the patient was investigated. Results The strain was resistant to all antibiotics used in routine drug susceptibility test except polymyxin and minocycline. The inhibition zone diameter of fosfomycin added later was 20mm. In synergistic drug susceptibility test,no synergistic antimicrobial activity was found between polymyxin,minocycline,fosfomycin and imipenem. Hodge test was positive; KPC-2 gene was detected by PCR and the sequence was consistent with AF297554 in GenBank. After treatment for one month,no extensively drug resistant Klebsiella pneumoniae strain was detected from the patients. Conclusion It is necessary to strengthen the monitoring of extensively drug resistant Klebsiella pneumoniae and improve the awareness of extensively drug resistant bacteria to facilitate the prevention and treatment of infectious disease.

关 键 词：泛耐药 KPC-2碳青霉烯酶 肺炎克雷伯菌 

分 类 号：R446.5[医药卫生—诊断学]