碳青霉烯耐药肺炎克雷伯菌致泌尿系统医院感染的特点及耐药机制研究  

Drug resistance mechanism and characteristics of nosocomial infection in urinary tract caused by carbapenem-resistant Klebsiella pneumoniae

作　　者：孙丹 姜飞 樊慧丽 杨荣胜 康海全 SUN Dan;JIANG Fei;FAN Hui-li;YANG Rong-sheng;KANG Hai-quan(Xuzhou Children＇s Hospital,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州市儿童医院检验科,江苏徐州221002 [2]徐州医科大学附属医院检验,江苏徐州221002 [3]徐州医科大学附属医院消化内科,江苏徐州221002

出　　处：《中华医院感染学杂志》2018年第20期3041-3044,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81471994);徐州市科技计划基金资助项目(KC16SH019)

摘　　要：目的分析医院碳青霉烯耐药肺炎克雷伯菌(carbapenemase resistant K. pneumoniae,CRKP)尿路感染的分子流行病学特点,为临床科学防控提供实验室依据。方法选择2016年1-12月医院引起医院尿路感染的非重复CRKP菌株18株,采用多位点序列分析(MLST)方法进行分型,并使用PCR方法检测常见碳青霉烯酶基因(DNM、KPC、SME、VIM、GES、IMP、OXA-48)和多黏菌素耐药基因MCR-1等。结果 18株医院尿路感染CRKP菌株,KPC-2基因携带率为94.44%(17/18),其中一株同时携带KPC和MCR-1基因,MLST分型以ST11型为主(88.89%,16/18)。结论 CRKP引起的尿路感染患者,多年龄偏大,有保留导尿和高级别抗菌药物使用史,应该规范抗菌药物使用与加强消毒隔离措施,控制流行传播。OBJECTIVE To analyze the clinical risk factors and molecular epidemiological characteristics of nosocomial CRKP infection in urinary tract,and to provide laboratory basis for clinical scientific prevention and control.METHODS The non-repetitive CRKP strains that caused urinary tract infection in a teaching hospital were collected from Jan.2016 to Dec. 2016,and were classified by multipoint sequence analysis（MLST）.The common carbapenem genes（DNM,KPC,SME,VIM,GES,IMP,OXA-48）and polymyxin resistance gene MCR-1 were detected by PCR method.RESULTS A total of 18 CRKP strains of nosocomial urinary tract infection were collected,and the KPC-2 gene carrying rate was 94.44%.One of them carried both KPC-2 and MCR-1 genes,and the MLST typing was dominated by ST11 type（88.89%,16/18）.CONCLUSION The patients with urinary tract infection caused by CRKP were usually at an old age,with a history of retention catheterization and use of highgrade antibiotics,and most of the CRKP strains that caused infection were type ST11 Klebsiella pneumoniae with KPC-2 type carbapenenes gene.It is necessary to standardize drug resistance and strengthen disinfection and isolation measures to control epidemic spread.

关 键 词：尿路感染 碳青霉烯耐药肺炎克雷伯菌 多黏菌素耐药基因 

分 类 号：R378[医药卫生—病原生物学]