82株肺炎克雷伯菌β-内酰胺耐药性与基因型相关性分析  

Analysis of the correlation between resistance to β-lactam antibiotics and the β-lactamase genotype in 82 strains of Klebsiella pneumoniae

作　　者：杨敏[1] 李欣 王敏[1] 李先平[1] 刘月 谢益欣 张衎[1] 田菁菁 唐爱国[1] YANG Min;LI Xin;WANG Min;LI Xian-ping;LIU Yue;XIE Yi-xin;ZHANG Kan;TIAN Jing-iing;TANG Ai-guo(Clinical Laboratory,The Second Xiangya Hospital affiliated with Central South University,Changsha 410011,China;Class starting in 2010,Department of Medical Laboratory Science,Xiangya Medical College,Central South University)

机构地区：[1]中南大学湘雅二医院检验科,湖南长沙410011 [2]中南大学湘雅医学院医学检验系2010级

出　　处：《中国病原生物学杂志》2018年第8期848-854,共7页Journal of Pathogen Biology

基　　金：中南大学2017年研究生自主探索创新项目(No.2017zzts844); 2017年湖南省技术创新引导计划项目(No.2017SK50122)

摘　　要：目的检测82株肺炎克雷伯菌β-内酰胺类抗生素耐药性,分析其与16种β-内酰胺酶基因的相关性。方法临床分离的肺炎克雷伯菌(KPN)82株,采用自动细菌检定系统检测其对18种常用β-内酰胺类抗生素的耐药性和16种β-内酰胺酶基因携带情况,并分析细菌耐药性与β-内酰胺酶基因型的相关性。结果临床分离株KPN对SCF耐药较高,为94.1%;对MPM的耐药率较低,为24.2%。82株KPN共检出SHV、TEM-1、KPC-2、NDM-1、OXA-1、OXA-2、CTX-M-3、CTX-M-14、CTX-M-15、CMY-4等10种β-内酰胺酶基因,其中前4种阳性率分别为100%、100%、7.3%和2.5%;碳青酶烯耐药株和碳青酶烯敏感株OXA-1、CMY-4、KPC-2及NDM-1基因阳性率分别为11.0%~100.0%,差异有统计学意义(P<0.05);基因型E型(SHV+TEM+CTX-M群+OXA群)较常见,检出率为48.8%,与药敏型Ⅷ型相符度(以药敏型为标准)为75%;基因型D型KPN中,药敏型Ⅰ型和Ⅱ型所占比例较高,达61.9%。结论长沙地区临床分离株KPNβ-内酰胺类抗生素耐药情况严重,β-内酰胺类耐药基因的携带也表现为多样化,其中SHV、TEM基因携带率高达100%,携带OXA-1、CMY-4、KPC-2及NDM-1的KPN更有可能对碳青霉烯类抗生素耐药,基因型为D型的KPN更有可能对非碳青霉烯β-内酰胺类抗生素耐药。Objectives To study the resistance of 82 strains of Klebsiella pneumoniae toβ-lactam antibiotics and to analyze the correlation between that resistance and 16β-lactamase genes. Method Eighty-two strains of K.pneumoniae isolated in various departments were tested for their resistance to 18 commonly usedβ-lactam antibiotics and the presence of 16β-lactamase genes.The correlation between theβ-lactamase genotype of strains and their drug resistance was also analyzed. Results Strains were most resistant to SCF（94.1%）and least resistant to MPM（24.2%）.The 82 strains of K.pneumoniae were tested for 10β-lactamase genes：SHV,TEM-1,KPC-2,OXA-2,NDM-1,OXA-1,OXA-2,CTX-M-3,CTX-M-14,CTX-M-15,and CMY-4.SHV was detected at a rate of 100%,TEM-1 was detected at a rate of100%,KPC-2 was detected at a rate of 7.3%,and OXA-2 was detected at a rate of 2.5%.In carbapenem-resistant strains,the rates at which KPC-2,CMY-4,OXA-1,and NDM-1 were detected（11-100%）differed significantly from rates in carbapenem-susceptible strains（P〈0.05）.Genotype E（SHV＋ TEM＋ CTX-M genes ＋ an OXA gene）was most common and was detected at a rate of 48.8%.The concordance between this genotype and type VIII susceptibility（based on the type of susceptibility）was 75%.Genotype D had the highest proportion of type I and type II susceptibility（61.9%）. Conclusion β-lactam antibiotic-resistant K.pneumoniae was common in Changsha,and strains had manyβ-lactamase genes.SHV and TEM were found in 100% of strains.Resistance toβ-lactam antibiotics is closely related toβ-lactamase genes,and the type ofβ-lactam antibiotic resistance was closely related to theβ-lactamase genotype.These findings provided a basis for studies on the resistance of K.pneumoniaetoβ-lactam antibiotics and the mechanism of thatresistance.In addition,strains with OXA-1,CMY-4,KPC-2,and NDM-1 are more likely to be resistant toβ-lactam antibiotics,and genotype D is more likely to be resistant to non-β-lactam antibiotics.

关 键 词：肺炎克雷伯菌 Β-内酰胺类抗生素 Β-内酰胺酶基因 药敏型 基因型 

分 类 号：R378[医药卫生—病原生物学]