耐药肺炎克雷伯菌湖北襄阳分离株获得性耐药元件研究  

Investigation of acquired resistant genes in a group of drug-resistant Klebsiella pneumoniae isolated from Xiangyang,Hubei Province

作　　者：史莉[1] 孙光成[1] 宋涛[1] 翁幸鐾[2] SHI Li SUN Guang-cheng SONG Tao WENG Xing-bei(Xiangyang No. 1 People ＇s Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院,湖北襄阳441000 [2]宁波市第一医院检验科,浙江宁波315010

出　　处：《中华医院感染学杂志》2017年第12期2649-2651,2655,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中医药基金资助项目(2011ZB126)

摘　　要：目的调查耐药肺炎克雷伯菌获得性耐药元件基因的携带情况及菌株间的亲缘关系,为临床治疗提供参考依据。方法收集2016年1-10月医院住院患者痰液标本分离15株耐药肺炎克雷伯菌,用K-B法测定9种抗菌药物的敏感性,采用聚合酶链反应(PCR)及序列分析的方法分析35种β-内酰胺类获得性耐药基因,21种氨基糖苷类获得性耐药基因和10种可移动遗传元件遗传标记;阳性耐药基因测序后直接作BLAST比对,耐药基因检测结果作样本聚类分析。结果 15株耐药肺炎克雷伯菌对β-内酰胺类、氨基糖苷类、喹诺酮类耐药率高;15株菌每株均检出β-内酰胺酶基因,总阳性率达100.0%,共检出7种β-内酰胺酶基因,其中仅检出1种β-内酰胺酶基因1株,占6.7%,同时检出2种9株,占60.0%,同时检出3种5株,占33.3%;样本聚类分析可见有一定的聚集性,并可分为A与B二个群;除A群有2个菌株属克隆传播,其余菌株亲缘关系稍远。结论本组15株耐药肺炎克雷伯菌同时携带β-内酰胺类药物获得性耐药基因、氨基糖苷类药物获得性耐药基因和可移动遗传元件遗传标记,是对β-内酰胺类和氨基糖苷类产生耐药的重要原因。OBJECTIVE To investigate the distribution of acquired resistant genes in a group of drug resistant Klebsiella pneumonia （DRK） and the phylogenetics of this group of DRK,so as to provide references for clinical treatment.METHODS From Jan.to Oct.2016,15 strains of DRK isolated from sputum were collected from Xiangyang No.1 People＆#39;s Hospital Affiliated to Hubei University of Medicine.Drug sensitivity to 9 kinds of antimicrobial agents were performed by K B method,then 35 kinds of acquired beta lactamase genes,21 kinds of acquired resistant genes to aminoglycosides,10 kinds of genetic markers of mobile genetic elements were analyzed by PCR and sequence analysis method.Positive resistant genes were verificated by DNA sequencing and BLAST algorithm.Finally,resistant genes were used as molecular markers to perform sample cluster analysis （UPGMA）.RESULTS Resistant rates of 15 strains of DRK to beta-lactams,aminoglycosides and quinolones were high.Beta-lactamase genes were positive in every strain（total resistant rate was 100.0%）,and 7 kinds were positive in this group of DRK.Moreover,1 kind of beta-lactamase gene was positive in 1 strain（6.7%）,2 kinds were positive in 9 strains （60%）,and 3 kinds were positive in5 strains（33.3%）.Furthermore,this group of DRK appeared some aggregation,and was divided into cluster A and B.Two strains in cluster A were clonal transmitted,but phylogenetics of other strains was at a little distance.CONCLUSION Fifteen strains of DRK carrying acquired resistant genes to beta-lactams and aminoglycosides,and genetic markers of mobile genetic elements,all play a key role in resistance to beta-lactams and aminoglycosides.

关 键 词：肺炎克雷伯菌 耐药 Β-内酰胺酶类 氨基糖苷类 可移动遗传元件 样本聚类分析 

分 类 号：R378.996[医药卫生—病原生物学]