泛耐药肺炎克雷伯菌对抗菌药物的耐药机制研究  

Drug resistance mechanisms of pandrug-resistant Klebsiella pneumoniae

作　　者：陈众博[1] 马红映[1] 邓在春[1] 汪丽[1] 吕丹[1] 孙士芳[1] 舒丽华[1] 王卫华[1] 

机构地区：[1]宁波大学医学院附属医院呼吸科,浙江宁波315020

出　　处：《中华医院感染学杂志》2014年第21期5210-5212,共3页Chinese Journal of Nosocomiology

基　　金：宁波市医学科研基金资助项目(2011B13)

摘　　要：目的通过检测一株泛耐药肺炎克雷伯菌对β-内酰胺类、氨基糖苷类和氟喹诺酮类抗菌药物耐药相关基因表达状况,分析该菌泛耐药的原因及其机制,为临床资料提供参考依据。方法回顾性分析2012年1月住院患者经API 20E系统初步鉴定菌种并经基因扩增与测序进一步确认的一株泛耐药肺炎克雷伯菌,采用聚合酶链反应(PCR)法分别检测β-内酰胺酶编码基因与膜孔蛋白编码基因、氨基糖苷类修饰酶编码基因和16SrRNA甲基化酶编码基因、拓普异构酶Ⅱ(DNA旋转酶)A亚单位和拓普异构酶ⅣC亚单位编码基因(gyrA、parC)突变分析以及可移动遗传元件标记基因。结果在该泛耐药肺炎克雷伯菌株中分别检出TEM、SHV、CTX-M-1群、KPC、DHA等5种β-内酰胺酶编码基因、aac(3)-Ⅱ、aac(6′)-Ⅰb、ant(3″)-Ⅰ等3种氨基糖苷类修饰酶编码基因、intⅠ1、tnpU、tnp513、IS26、IS903、ISEcp1、ISKpn6、trbC等8种可移动遗传元件标记基因,并发现gyrA和parC基因存在突变,但膜孔蛋白编码基因检测呈阴性。结论借助于可移动遗传元件而获得广泛耐药基因并表达5种β-内酰胺酶编码基因和3种氨基糖苷类修饰酶编码基因、且存在gyrA基因与parC基因的有义突变,是该菌株泛耐药的主要原因与机制。OBJECTIVE To detect theβ-lactams-, aminoglycosides-, and quinolones-resistance genes in a pandrug-resistant K lebsiella pneumoniae isolate and analyze the causes of pandrug-resistance as well as the resistance mech-anisms so as to provide bases for clinical data .METHODS A pandrug-resistant K .pneumoniae, which was primari-ly identified through API 20 E system and further confirmed by gene amplification and sequence in a hospitalized patient in Jan 2012, then the polymerase-chain-reaction （PCR） method was employed to detect theβ-lactamase en-coding gene, membrane pore protein-coding genes, aminoglycoside-modifying enzyme genes, 16SrRNA methylase encoding gene, topoisomerase Ⅱ （ DNA gyrase） subunit A, and topoisomerase Ⅳ subunit C （gyrA、parC） as well as the mobile genetic elements genes .RESULTS Totally 5 kinds of β-lactams-resistance genes （TEM, SHV, CTX-M-1-like, KPC, and DHA ）, 3 kinds of aminoglycoside-modifying enzyme genes （aac（3）-Ⅱ, aac（6′）-Ⅰb, and ant （3″）-Ⅰ ）, and 8 kinds of mobile genetic elements markers （ intⅠ 1, tnpU, tnp513, IS26, IS903, ISEcp1, ISK pn6, and trbC） have been detected in this pandrug-resistant K .pneumoniae isolate, the mutations of gyrA and parC genes were found, however, the membrane pore protein-coding genes were tested negative. CONCLUSION The acquired pandrug-resistance genes by means of the mobile genetic elements, the expression of 5 kinds ofβ-lactams-resistance genes and 3 kinds of aminoglycoside-modifying enzyme genes, and sense mutations of gy rA and p arC genes are the main pandrug-resistant mechanisms of this strain .

关 键 词：肺炎克雷伯菌 泛耐药 获得性耐药机制 

分 类 号：R378.996[医药卫生—病原生物学]