产NDM-1、IMP-4和KPC-2碳青霉烯酶肺炎克雷伯菌耐药特点  

Antibiotics resistance characterization of NDM-1,IMP-4 and KPC-2-producing Klebsiella pneumonia strains

作　　者：张盼[1] 林祥芳[1] 刘彩霞[1] 林玲[1] 余坚[1] 李向阳[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院检验科,浙江温州325000

出　　处：《中国卫生检验杂志》2015年第5期734-738,共5页Chinese Journal of Health Laboratory Technology

基　　金：温州市科技局课题项目(Y20140045)

摘　　要：目的探讨本院临床分离的碳青霉烯类耐药肺炎克雷伯菌(CRKP)耐药基因的携带情况及对17种常用抗菌药物的耐药特点。方法采用VITEK Compact-2全自动微生物分析系统进行菌株的鉴定和药敏试验,收集耐碳青霉烯类药物肺炎克雷伯菌24株,采用改良Hodge试验筛查碳青霉烯酶;PCR技术扩增耐药基因,包括碳青霉烯酶、超广谱β-内酰胺酶(ESBLs)和Amp C酶基因,并对扩增产物进行测序和BLAST比对分析。结果菌株对头孢菌素类、单环内酰胺类、β-内酰胺酶抑制剂复合物、氟喹诺酮类和呋喃妥因等抗菌药物表现出较高的耐药性,但对氨基糖苷类药物丁胺卡那和妥布霉素的敏感性较好,敏感率分别为100.0%和62.5%。24株耐药菌株中,有16株改良Hodge试验阳性,阳性率为66.7%;PCR扩增结果显示:12株检测出blaKPC-2基因,3株检测到blaIMP-4基因,2株blaNDM-1阳性,所有菌株都携带blaSHV基因,12株携带blaTEM基因,13株携带blaCTX-M基因,7株携带blaDHA基因。结论本院CRKP以产KPC-2为主,但同时还出现了NDM-1和IMP-4金属酶。Objective To investigate the prevalence of resistance genes and the antibiotic susceptibility in carbapenems - resistant Klebsiella pneumonia strains isolated from the second affiliated hospital of Wenzhou medical university and the characteristics of 17 kinds of commonly used antimicrobial resistance. Methods A total of 24 strains of carbapenems - resistant Klebsiella pneumonia antimicrobial susceptibility were analyzed by VITEK compact - 2 automatic system. Carbapenemases were screened by modified hodge test. β - lactamase genes, including carbapenemases, ESBLs and AmpC were examined by PCR ahd sequencing. Results Clinical isolates showed highly resistance to cephalosporins, monobactams, β -lactamase inhibitor combinations, fluoroquinolones and nitrofurantoin, relatively better susceptibility to aminoglycosides Amikacin and Tobramycin, and susceptibility rates were 100.0% and 62.5%, respectively. 16 of 24 clinical isolates Modified Hodge test were positive, and positive rate was 66.7%. PCR amplification resuhs showed that 12 isolates were tested blaKPC-2, 3 isolates were tested blaIMP-4 and 2 isolates were blaNDM-1 positive. All strains carried blaSHV genes, 12 strains carried blaTEM genes, 12 strains harboured blaCTX-M genes and 7 strains harboured blaDHA genes. Conclusion KPC -2 was the major carbapenemase in CRKP, whereas NDM - 1 and IMP - 4 metallo - β- lactamase were emerged.

关 键 词：肺炎克雷伯菌 碳青霉烯酶 改良HODGE试验 

分 类 号：R446.5[医药卫生—诊断学]