产KPC肺炎克雷伯菌暴发流行的药敏特点与同源性分析  

Drug susceptibility of prevalent KPC-producing Klebsiella pneumoniae and analysis of molecular epidemiology

作　　者：梁慧[1] 赵树龙[2] 张薇[1] 王玉飞[1] 刘佳[1] 胡红焱[1] 

机构地区：[1]武警总医院检验科,北京100039 [2]徐州医学院附属医院检验科,江苏徐州221002

出　　处：《中华医院感染学杂志》2016年第22期5046-5049,共4页Chinese Journal of Nosocomiology

基　　金：中华医院感染控制研究基金资助项目(ZYGY001);武警总医院科研基金资助项目(WZ20130109)

摘　　要：目的研究分析北京某三甲医院2014年10-11月产KPC型碳青霉烯酶肺炎克雷伯菌暴发流行的药敏特点及其与同源性的关系,为进行有效预防控制提供分子流行病学证据。方法收集2014年10-11月分离自临床和医院感染监测产KPC酶肺炎克雷伯菌20株,通过PCR测定KPC型碳青霉烯酶基因,微量肉汤法测定最小抑菌浓度,对于感染有KPC型肺炎克雷伯菌患者的临床资料进行回顾性调查与研究。结果分离鉴定出产KPC肺炎克雷伯菌外科ICU 11株、内科ICU 2株、其他科室7株;分为A型和B型,其中A型共17株,B型3株;A型菌株除对米诺环素、多粘菌素B敏感外对其余包括碳青霉烯类抗菌药物在内的所有抗菌药物均表现出不同程度的耐药,B型菌株对米诺环素、多粘菌素B、庆大霉素、阿米卡星表现出一定程度的敏感外,对其他抗菌药物也均表现为不同程度的耐药。结论本次产KPC型肺炎克雷伯菌暴发,存在克隆传播的可能,不同的克隆株对药物的敏感性有较大差异,对临床的抗菌药物应用带来极大挑战,同时临床科室应积极加强防护措施,防止再次产KPC型肺炎克雷伯菌暴发流行。OBJECTIVE To explore the characteristics of drug susceptibility of KPC‐producing K lebsiella pneumon‐iae strains that were prevalent in a three A hospital in Beijing from Oct 2014 to Nov 2014 and analyze the correla‐tion between the drug susceptibility and the homology so as to provide molecular epidemiological evidence for effec‐tive prevention and control .METHODS A total of 20 strains of KPC‐producing K .pneumoniae were collected from patients with clinical and nosocomial infections from Oct 2014 to Nov 2014 ,then the KPC carbapenemase genes were determined by using PCR ,the minimal inhibitory concentration was measured with the use of micro‐broth di‐lution method ,and the clinical data of the patients with the KPC‐producing K .pneumoniae infection were retro‐spectively investigated and studied .RESULTS Totally 11 strains of KPC‐producing K .pneumoniae were isolated from the surgery department ICUs ,2 strains from internal medicine department ICUs ,7 strains from other de‐partment .The strains were divided into the type A （17 strains ） and type B （3 strains ） .The type A strains var‐ied in the drug resistance to all of the antibiotics including carbapenems but were susceptible to minocycline and polymyxin B .The type B strains showed certain susceptibility to minocycline ,polymyxin B ,gentamicin ,and ami‐kacin and varied in the drug resistance to other antibiotics .CONCLUSION There might be clone transmission in this time of outbreak of KPC‐producing K .pneumoniae .The clone strains vary significantly in the susceptibility to drugs ,which brings great challenge to the clinical use of antibiotics .It is necessary for the clinical department to actively strengthen the implementation of prevention measures so as to prevent the outbreak and prevalence of the KPC‐producing K .pneumoniae .

关 键 词：肺炎克雷伯菌 KPC 脉冲场电泳 

分 类 号：R378.996[医药卫生—病原生物学]