耐亚胺培南肺炎克雷伯菌的耐药机制研究  

Drug resistance mechanisms of imipenem-resistant Klebsiella pneumoniae

作　　者：豆清娅[1] 邹明祥[2] 李春辉[1] 李军[2] 胡咏梅[2] 王海晨[2] 吴安华[1] 

机构地区：[1]中南大学湘雅医院感染控制中心,湖南长沙410008 [2]中南大学湘雅医院检验科,湖南长沙410008

出　　处：《中华医院感染学杂志》2016年第13期2906-2909,共4页Chinese Journal of Nosocomiology

基　　金：湖南省科技计划基金资助项目(2012SK3200)

摘　　要：目的探讨耐亚胺培南肺炎克雷伯菌的流行病学特征和β-内酰胺酶基因型,为临床合理用药和感染控制提供依据。方法收集2014年2-11月临床分离25株耐亚胺培南肺炎克雷伯菌,采用VITEK-2微生物系统检测菌株的药物敏感性;改良Hodge试验检测碳青霉烯酶;PCR检测β-内酰胺酶基因KPC-2、SHV、CTX-M、IMP、VIM、NDM-1、OXA-48;采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC-PCR)对菌株进行同源性分析。结果在检测的18种药物中,哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢唑林、头孢曲松、氨苄西林、厄他培南、亚胺培南、氨曲南的耐药率均为100.0%,磺胺甲噁唑/甲氧苄啶的耐药率最低为32.0%,其次为阿米卡星和妥布要素均为(68.0%);改良Hodge试验阳性20株(80.0%);25株菌均检测到SHV基因,20株菌检测到CTX-M基因,15株检测到KPC-2基因,1株菌检测到IMP-4基因,3株菌检测到NDM-1基因,未检测到VIM、OXA-48基因;25株菌分为6型,为A、B、C、D、E、F,分别有15、5、2、1、1、1株。结论耐亚胺培南的肺炎克雷伯菌多药耐药严重,产生β-内酰胺酶是菌株对多种药物耐药的主要机制,且菌株存在克隆性传播,3株菌检测到NDM-1基因,应引起相关部门的重视。OBJECTIVE To study the epidemiological characteristics and genotypes ofβ-lactamase in imipenem-resistant Klebsiella pneumoniae so as to provide guidance for reasonable clinical use of antibiotics and control of infections.METHODS A total of 25 strains of imipenem-resistant K.pneumoniae were collected from Feb 2014 to Nov 2014.The drug susceptibility was tested by microorganism analytical system VITEK-2,the modified Hodge test was carried out to screen carbapenemases of the strains,PCR was used to detect KPC-2,SHV,CTX-M,IMP,VIM,NDM-1,and OXA-48ofβ-lactamase genes.The homology of the 25 strains was analyzed by mean of enterobacterial repetitive intergenic consensus-PCR（ERIC-PCR）.RESULTS Among the 18 antibiotics tested,the drug resistance rates to piperacillin-tazobactam,ampicillin/sulbactam,cefazolin,ceftriaxone,ampicillin,ertapenem,imipenem,and aztreonam were 100.0%;the drug resistance rate to sulfamethoxazole-trimethoprim was the lowest（32.0%）,followed by amikacin and tobvamyin toth（68.0%）.The modified Hodge test showed that 20strains（80.0%）were positive;totally 25 strains were tested positive for SHV gene,20 strains were tested positive for CTX-M gene,15 strains were tested positive for KPC-2gene,1strain was tested positive for IMP-4gene,3strains were tested positive for NDM-1gene,and VIM and OXA-48 genes were tested negative.The 25 strains were classified into 6genotypes,namely as the followsing：A（15strains）,B（5strains）,C（2strains）,D（1strain）,E（1strain）,and F（1strain）.CONCLUSION The imipenem-resistant K.pneumoniae strains are highly multidrug-resistant;the production of theβ-lactamase is the leading mechanism for the resistance to multiple antibiotics,and there is a clonal spread in the area,and 3strains carrying NDM-1gene,to which great attention should be paid.

关 键 词：肺炎克雷伯菌 亚胺培南 Β-内酰胺酶 NDM-1 同源性 

分 类 号：R378.996[医药卫生—病原生物学]