携带blaKPC-2基因肺炎克雷伯菌引起儿童医院感染暴发的研究  

Nosocomial Outbreak of KPC-2-producing ST11 Klebsiella pneumoniae in a Children's Hospital in China

作　　者：张会 赵辉[2] 董丹丹 刘真真 贾楠[2] 朱元祺[1,2] ZHANG Hui;ZHAO Hui;DONG Dan-dan(The Medical College of Qingdao University,Qingdao,Shandong 266071,China;Department of Clinical Laboratory,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学医学院,山东青岛266071 [2]青岛大学附属医院检验科,山东青岛266555

出　　处：《中国实验诊断学》2019年第1期136-139,共4页Chinese Journal of Laboratory Diagnosis

基　　金：山东青岛开发区重点科技发展项目(2013-1-82)

摘　　要：目的调查分析某儿童医院分离的对碳青霉烯类耐药肺炎克雷伯菌的耐药基因和菌株间的同源性,为医院感染控制提供依据。方法收集非重复9株对碳青霉烯类耐药肺炎克雷伯菌。菌株的鉴定和药敏试验采用梅里埃Vitek-2Compact系统。碳青霉烯酶和超广谱β-内酰胺酶耐药相关基因通过PCR扩增和产物测序确定。多位点序列分型和脉冲场凝胶电泳及应用BioNumerics聚类软件分析菌株之间的同源性。结果除了磺胺甲恶唑/甲氧苄啶外,9株肺炎克雷伯菌对头孢菌素类、碳青霉烯类、氨基糖苷类和喹诺酮类抗生素都耐药。在9株菌中,8株为ST11型,都携带blaKPC-2、blaCTX-M-65、blaSHV-12和blaTEM-1B耐药基因,且相互间脉冲场凝胶电泳聚类分析有92.8%-100%的相似度;另外1株为ST278型,仅携带blaKPC-2基因,与8株ST11型肺炎克雷伯菌的聚类分析相似度为64.3%。结论携带blaKPC-2、blaCTX-M-65、blaSHV-12和blaTEM-1B基因的ST11型肺炎克雷伯菌的克隆播散是引起患儿医院感染暴发的原因。经检索,这是国内外首次报道。Objective To investigate the antimicrobial resistance genotype and relatedness of carbapenem-resistant K.pneumoniaeisolates so as to provide practice guidelines for nosocomial infection prevention.Methods Total non-duplicate 9K.pneumonias were collected.The identification and antibiotic susceptibility tests of these isolates were done by using VITEK-2Compact system.The antimicrobial resistance genes encoding the carbapenemases and extendedspectrum-β-lactamases were detected by using PCR and product sequencing.The clonal relatedness of the strains was determined by multilocus sequence typing(MLST)and pulsed-field gel electrophoresis(PFGE),and were analyzed by Dice similarity with BioNumerics(7.6).Results The nine isolates were highly resistant to these antimicrobial agents of cephalosporins,carbapenems,aminoglycosides and fluoroquinolones except for Trimethoprim-sulfamethoxazole.Out of nine K.pneumoniaes,eights were confirmed to belong to the sequence type 11(ST11),harbored blaKPC-2、blaCTXM-65、blaSHV-12 and blaTEM-1Bgenes,and other one which belong to the sequence type 278(ST278)carried only one blaKPC-2gene.The PFGE revealed that the eights ST11 K.pneumoniae were clonally related and that the Dice similarity with BioNumerics were 92.8%-100%in these ST11 strains,64.3% between eight ST11 and one ST278 Klebsiella pneumonia,respectively.Conclusion The clonal spread of K.pneumoniae ST11 expressing KPC-2,CTX-M-65SHV-12 and TEM-1Bβ-lactamases was the cause of an nosocomial outbreak of carbapenem-resistant Klebsiella pneumonia in the children’s hospital.To the best of our knowledge,it has not previously been reported in the world.

关 键 词：肺炎克雷伯菌 KPC-2 儿童 医院感染 

分 类 号：R563.1[医药卫生—呼吸系统]