郑州市耐碳青霉烯类肺炎克雷伯菌耐药趋势分析  

Drug resistance of carbapenem-resistant Klebsiella pneumoniae isolates in Zhengzhou

作　　者：李永伟[1] 许晓娜[2] 王志盛 张小倩[1] 刘心伟 郭孝兰 LI Yong-wei;XU Xiao-na;WANG Zhi-sheng;ZHANG Xiao-qian;LIU Xin-wei;GUO Xiao-lan(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou,Henan 450002,China)

机构地区：[1]河南省中医院检验科,河南郑州450002 [2]河南中医药大学第二临床医学院,河南郑州450008

出　　处：《中华医院感染学杂志》2018年第21期3207-3210,3214,共5页Chinese Journal of Nosocomiology

基　　金：河南省中医药科学研究专项基金资助项目(2016ZY1008)

摘　　要：目的了解本地区耐碳青霉烯类肺炎克雷伯菌(CRKP)表型并进一步分析其耐药机制,帮助临床合理使用抗菌药物。方法收集2014年1月-2017年8月细菌感染患者送检标本中分离的CRKP菌株82株,统计流行病学特征,用WHONET 5.6软件分析结果,EDTA双纸片协同法检测金属酶表型,PCR方法检测耐药基因。结果 82株CRKP中,科室主要分布在重症医学科和神经外科,标本主要为痰和尿。耐药特征表现为对包括碳青霉烯类在内的绝大部分β-内酰胺类抗菌药物耐药或敏感性降低,部分菌株对米诺环素、替加环素、磷霉素仍保持较高的敏感性。表型检测产金属酶的有20株,耐药机制检测结果显示有64株肺炎克雷伯菌产碳青霉烯酶(KPC)。结论本地区耐碳青霉烯类肺炎克雷伯菌耐药机制主要以KPC为主,临床应加强对其监测,合理使用抗菌药物。OBJECTIVE To understand the phenotypes of carbapenem-resistant Klebsiella pneumoniae（CRKP）isolates and further analyze the drug resistance mechanisms of the strains so as to provide guidance for reasonable clinical use of antibiotics.METHODS From Jan 2014 to Aug 2017,totally 82 strains of CRKP were isolated from submitted specimens of the patients with bacterial infection,the epidemiological characteristics were statistically analyzed,and the result was analyzed by using WHONET 5.6 software,the phenotypes of metalloenzyme were detected by using EDTA double disk synergy method,and the drug resistance genes were detected with the use of PCR.RESULTS Among the 82 strains of CRKP,most of the strains were isolated from critical care medicine department and neurosurgery department and were mainly isolated from sputum and urine specimens.The strains were resistant to most ofβ-lactams,including carbapenems,and some of the strains remained highly susceptible to minocycline,tigecycline and fosfomycin.The result of the phenotype test showed that there were 20 metalloenzyme-producing strains,and the result of drug resistance mechanisms test indicated that there were 64 strains of CRKP.CONCLUSIONThe CRKP strains are dominant among the carbapenems-resistant K.pneumoniae strains.It is necessary for the hospital to strengthen the monitoring of the strains and reasonably use antibiotics.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 耐药基因 感染控制 

分 类 号：R378.996[医药卫生—病原生物学]