耐碳青霉烯类肺炎克雷伯菌的基因型及同源性分析  

Genotype and homology analysis of carbapenems-resistant Klebisella pneumoniae

作　　者：张伟铮[1] 何慧婵[2] 许振杰[1] 李松[1] 屈平华[1] 陈茶[1] 

机构地区：[1]广东省中医院大学城医院检验科,广州510006 [2]广东医学院医学检验学院,广东东莞528300

出　　处：《临床检验杂志》2015年第5期391-394,共4页Chinese Journal of Clinical Laboratory Science

基　　金：国家自然科学基金(31300004);广东省中医药局科研课题(20132132)

摘　　要：目的探讨耐碳青霉烯类肺炎克雷伯菌的耐药性、基因型和同源性。方法收集临床采集的碳青霉烯类耐药肺炎克雷伯菌23株,检测其药物敏感性和ESBLs表型,改良Hodge试验确证碳青霉烯酶表型,PCR、DNA测序和BLAST证实基因型,脉冲场电泳(PFGE)分析产酶菌株同源性。结果 23株肺炎克雷伯菌对碳青霉烯类抗生素完全耐药,其中47.8%来源于痰液标本,主要分布在神经外科重症监护室(NCU)。23株菌ESBLs和改良Hodge试验阳性率分别为21.7%、82.6%,检出SHV-11(22株)、KPC-2(14株)、NDM-1(6株)、VEB(2株)、IMP(1株)、OXA-1(2株)和OXA-10(2株)耐药基因。PFGE将23株菌基因分成A^G 7个带型,其中以A型为主(69.6%,16/23)。结论碳青霉烯酶基因型以KPC-2型及NDM-1型为主,院内存在克隆株流行。Objective To investigate the drug resistance,genotype and homology of carbapenems-resistant Klebisella pneumoniae.Methods A total of 23 clinical isolates of Klebisella pneumoniae suspected to be resistant to carbapenems were collected,and their drug susceptibility and ESBLs phenotype were determined. The production of carbapenemase was confirmed by modified Hodge test（ MHT）. The genotype of carbapenems-resistant Klebisella pneumoniae was determined by PCR,DNA sequencing and BLAST database,and their homologies by pulsed-field gel electrophoresis（ PFGE）. Results All of 23 isolates were confirmed to be resistant to carbapenems,of which 47. 8% were isolated from sputum specimens of the patients hospitalized in Neurosurgery intensive care unit（ NCU）. The positive rates of ESBLs and MHT in 23 isolates were 21. 7% and 82. 6%,respectively. The drug resistance genes,including 22 isolates of SHV-11,14 KPC-2,6 NDM-1,2 VEB,2 OXA-1,2 OXA-10 and 1 IMP,were detected. The PFGE showed 7band types with A ~ G,and 16 isolates（ 69. 6%,16 /23） belonged to type A. Conclusion The most common carbapenemase genotypes are KPC-2 and NDM-1,indicating that there exists epidemic isolates in the hospital.

关 键 词：肺炎克雷伯菌 耐碳青霉烯类 基因分型 同源性 

分 类 号：R446.5[医药卫生—诊断学]