同一患者不同部位分离耐碳青霉烯类肺炎克雷伯菌耐药机制研究及同源性分析  

Drug resistant mechanism and homology analysis of carbapenem-resistant Klebsiella pneumoniae isolated from different sites of one patient

作　　者：胡咏梅[1] 邹明祥[1] 李军[1] 豆清娅[2] 王海晨[1] 晏群[1] 刘文恩[1] HU Yong-mei ZOU Ming-xiang LI Jun DOU Qing-ya WANG Hai-chen YAN Qun LIU Wen-en(Department of Clinical Laboratory Infection Control Center, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China)

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

出　　处：《临床检验杂志》2017年第7期511-513,517,共4页Chinese Journal of Clinical Laboratory Science

基　　金：湖南省发改委(湘发改高技[2012]1493号;湘发改投资[2014]658号);湖南省自然科学基金(14JJ7003)

摘　　要：目的对临床分离自同一患者不同部位的3株耐碳青霉烯类肺炎克雷伯菌进行耐药机制研究及同源性分析。方法对某严重烧伤患者的股静脉导管尖端、创面分泌物及痰液标本中分离到的3株耐碳青霉烯类肺炎克雷伯菌,采用改良Hodge试验检测碳青霉烯酶,双纸片协同及增效试验检测金属β-内酰胺酶;PCR筛查耐药基因;肠杆菌科基因间重复序列-聚合酶链反应(ERIC-PCR)进行同源性分析,多位点序列分型技术(MLST)对肺炎克雷伯菌进行分子生物学分型。结果 3株耐碳青霉烯类肺炎克雷伯菌的改良Hodge试验均为阴性,双纸片协同及增效试验均为阳性;3株菌均检出blaNDM-1基因,而未检出bla_(KPC)、bla_(GES)、bla_(IMP)、bla_(SPM)、bla_(VIM)、bla_(GIM)及bla_(OXA-48)等耐药基因;ERIC-PCR显示3株菌为同一型别,MLST分型结果显示3株菌均属于ST17型。结论 3株肺炎克雷伯菌对碳青霉烯类抗生素耐药的主要机制为携带bla_(NDM-1)基因,且这3株菌为同一克隆。Objective To investigate the drug resistant mechanism and homology of three strains of carbapenem-resistant Klebsiella pneumoniae（ K. pneumoniae） isolated from different sites of one patient. Methods Three strains of carbapenem-resistant K. pneumoniae were isolated from femoral vein catheter tip,wound secretions and sputum of a patient with severe burns,respectively. Their carbapenemase,metallo-β-lactamase（ MBL） and drug resistance genes were detected by modified Hodge test,double-disk synergy test and combination disk diffusion and PCR,respectively,and homology and biological typing were analyzed by enterobacterial repetitive intergenic consensus-PCR（ ERIC-PCR） assay and multilocus sequence typing（ MLST） technology,respectively. Results The carbapenemase and MBL of three strains of carbapenem-resistant K. pneumoniae were negative and positive,respectively. The blaNDM-1 gene was identified from the three strains,but other drug resistance genes such as bla_（KPC）,bla_（GES）,bla_（IMP）,bla_（SPM）,bla_（VIM）,bla_（GIM） and bla_（OXA-48） were not detected. ERIC-PCR showed that three isolates belonged to the same genotype,and MLST showed that they were type ST17. Conclusion Carring bla_（NDM-1）gene is the main cause leading to the drug resistance of three strains of carbapenem-resistant K. pneumoniae,and they belong to the same genotype.

关 键 词：多部位感染 肺炎克雷伯菌 新德里金属β-内酰胺酶Ⅰ型 多位点序列分型 

分 类 号：R446.5[医药卫生—诊断学]