产ESBL肺炎克雷伯菌的β-内酰胺类与氨基糖苷类和磺胺类耐药元件分析  

Investigation of resistant genes to beta-lactams,aminoglycosides and sulfanilamides in a group of ESBL-producing Klebsiella pneumoniae

作　　者：秦声远 陈风[1] 翁幸鐾[2] 

机构地区：[1]湖北省监利县人民医院检验科,湖北监利县433300 [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21期4815-4818,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中医药基金资助项目(2011ZB126)

摘　　要：目的调查一组20株产ESBL肺炎克雷伯菌中β-内酰胺类、氨基糖苷类与磺胺类获得性耐药元件基因的携带状况,以及菌株间的亲缘关系。方法收集2015年1月-6月医院住院患者标本中分离的20株产ESBL肺炎克雷伯菌,采用聚合酶链反应(PCR)及序列分析的方法分析23种β-内酰胺类耐药基因、11种氨基糖苷类耐药基因、5种磺胺类耐药基因、8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(UPGMA法)。结果 20株产ESBL肺炎克雷伯菌每株均检出β-内酰胺类耐药基因、磺胺类耐药基因和可移动遗传元件遗传标记基因,阳性率达100.0%,有19株检出氨基糖苷类药物获得性耐药基因,阳性率95.0%;20株菌共检出6种β-内酰胺酶类耐药基因、4种氨基糖苷类耐药基因、3种磺胺类耐药基因、6种可移动遗传元件遗传标记,且阳性率较高;样本聚类分析显示菌株有聚集性,共有12-14号株、7-20号株、15-18-19号株、8-9号株4个克隆传播。结论本组20株产ESBL肺炎克雷伯菌携带的β-内酰胺类耐药基因、氨基糖苷类耐药基因、磺胺类耐药基因和可移动遗传元件遗传标记是对β-内酰胺类、氨基糖苷类、磺胺类产生耐药的重要原因,本组菌检出的四个克隆高度疑似医院感染。OBJECTIVE To investigate the distribution of resistant genes to beta-lactams,aminoglycosides and sulfanilamides in a group of ESBL-producing Klebsiella pneumoniae and to investigate phylogenetics of this group of K.pneumoniae.METHODS From Jan.to Jun.2015,20 strains of ESBL-producing K.pneumoniaee were collected from Jianli People＇s Hospital,Hubei Province,China.The 23 kinds of beta-lactams genes,11 kinds of resistant genes to aminoglycosides,5 kinds of resistant genes to sulfanilamides,and 8 kinds of genetic markers of mobile genetic elements were analyzed by PCR.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 genes to beta-lactams,sulfanilamides and genetic markers of mobile genetic elements were positive in every strain,with the positive rate of 100.0%,and resistant genes to aminoglycosides were positive in 19 strains,with the positive rate of 95.0%.There were 6 kinds of resistant genes to beta-lactams,4 kinds of resistant genes to aminoglycosides,3 kinds of resistant genes to sulfanilamides,and 6 kinds of genetic markers of mobile genetic elements were detected in 220 strains of K.pneumoniae,and positive rates were high.Furthermore,the group of strains appeared aggregation,and 4 clones existed：strain No.12-14,strain No.7-20,strain No.15-18-19,and strain No.8-9.CONCLUSIONResistant genes to beta-lactams,aminoglycosides,sulfanilamides and mobile genetic elements in a group of ESBL-producing K.pneumoniaee play a key role in resistance to beta-lactams,aminoglycosides and sulfanilamides.Four clones in this group of K.pneumoniae are suspected nosocomial infections.

关 键 词：肺炎克雷伯菌 耐药 Β-内酰胺类 氨基糖苷类 磺胺类 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]