肺炎克雷伯菌产碳青霉烯酶特性与耐药趋势研究  

Analysis of mechanism and antibiotic resistance trends in carbapenem-resistant Klebsiella pneumonia

作　　者：陈玉宇[1] 李辉军[1] 许春燕[1] 余素飞[1] 

机构地区：[1]台州医院检验科,浙江临海317000

出　　处：《中国微生态学杂志》2015年第2期174-177,181,共5页Chinese Journal of Microecology

摘　　要：目的探讨临床分离的耐碳青霉烯类肺炎克雷伯菌(Klebsiella pneumoniae carbapenem-resistant,CRKP)的耐药机制及耐药趋势,为抗感染治疗提供依据。方法收集2008-2013年分离的CRKP 178株,分别运用VITEK-2 Compact全自动细菌分析仪和K-B纸片法检测菌株对药物的敏感性,改良Hodge试验确定是否产碳青霉烯酶以及EDTA抑制试验确定是否产金属酶,用PCR扩增和基因测序技术检测耐药基因。结果临床分离出肺炎克雷伯菌(Klebsiella pneumonia,Kpn)中CRKP的比例从2008年0.1%升至2013年2.2%,呈明显上升趋势;药敏结果显示,其对碳青霉烯类高度耐药外,对头孢曲松、氨曲南、环丙沙星等多种抗菌药物呈现出多重耐药;改良Hodge试验阳性170株(阳性率为95.5%);EDTA双纸片协同试验阳性1株(阳性率为0.6%)。PCR共检出150株携带KPC-2酶基因(blaKPC-2),阳性率为84.3%(150/178),1株肺炎克雷伯菌同时携带blaKPC-2和blaIMP-4,占0.6%(1/178)。结论台州医院分离的CRKP比例逐年升高,对多种抗菌药物高度耐药,产KPC-2型碳青霉烯酶是分离菌株对碳青霉烯类抗菌药物耐药主要原因。Objective To analyze mechanism and antibiotic resistance trends in carbapenem-resistant Klebsiella pneumonia so as to provide basis for reasonable use of antibiotics. Methods A total of l78 clinical isolates of Carbapenems-resistant Klebsiella pneumoniae were isolated from clinical specimens from January 2008 to December2013. The antimicrobial susceptibility tests were performed by using automatic microbial analyzer Vitek-2 Compact and K-B method in accordance with United States Clinical and Laboratory Standards Institute（ CLSI）. The carbapenemase was confirmed by modified Hodge test（ MHT）. Ethylene diamine tetraacetic acid（ EDTA） disk diffusion method was used for detection of metal enzyme phenotypes. The genes of carbapenemase were detected by PCR and gene sequencing technology. Results The proportion of CRKP showed a rising trend,0. 1% rising to 2. 2% from2008 to 2013; Susceptibility results showed highly resistant to Carbapenems and multiple resistant to Ceftriaxone,Aztreonam,Ciprofloxacin and other antibacterial drugs. Of all the 178 clinical isolates of carbapenems-resistant Klebsiella pneumoniae,95. 5%（ 170 /178） strains appeared positive response of modified Hodge test; 0. 6%（ 1 /178） strains appeared positive response of EDTA disk diffusion method. PCR and sequencing analysis showed that 84. 3%（ 150 /178） strains harbored blaKPC-2genes,0. 6%（ 1 /178） strain harbored both blaKPC-2and blaIMP-4genes. Conclusion The proportion of CRKP isolated in our hospital increases year by year; They are highly resistant to multiple antimicrobial drugs and the major genotype causing Carbapenems resistance in Klebsiella pneumoniae is blaKPC-2.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 基因型 耐药率 

分 类 号：R378.996[医药卫生—病原生物学]