院内耐阿米卡星肺炎克雷伯菌氨基糖苷类耐药机制和分子流行病学研究  

Mechanism of aminoglycoside resistance and molecular epidemiology of amikacin-resistant Klebsiella pneumoniae in hospital

作　　者：刘丽[1] 李琳[2] 姜梅杰[3] Liu Li;Li Lin;Jiang Meijie(Department of Infectious Disease,Central Hospital of Taian,Taian 271000,China;Infection Management,Central Hospital of Taian,Taian 271000,China;Clinical Laboratory,Central Hospital of Taian,Taian 271000,China)

机构地区：[1]泰安市中心医院感染科,271000 [2]泰安市中心医院感染管理科,271000 [3]泰安市中心医院检验科,271000

出　　处：《中华临床实验室管理电子杂志》2018年第1期39-42,共4页Chinese Journal of Clinical Laboratory Management(Electronic Edition）

基　　金：泰安市一般计划项目资助课题(201340629)

摘　　要：目的研究临床分离的耐阿米卡星肺炎克雷伯菌亲缘关系及氨基糖苷类耐药基因的流行情况及标本分布,为临床感染控制提供依据。方法采用WalkAway 96 PLUS全自动细菌鉴定及药敏分析仪,对2013年6月—2014年11月院内临床分离的27株耐阿米卡星肺炎克雷伯菌,进行细菌鉴定和药敏试验,采用纸片扩散法和E-test法检测部分抗菌药物的敏感性。用聚合酶链式反应(polymerase chain reaction,PCR)检测氨基糖苷类耐药基因,并对部分阳性基因进行测序。多位点序列分型法(multilocus sequence typing,MLST)鉴定菌株之间的亲缘关系。结果 27株耐阿米卡星肺炎克雷伯菌中,88.9%(24/27)16S rRNA甲基化酶基因rmtB阳性,51.9%(14/27)aac(3)-Ⅱ、40.7%(11/27)aac(6′)-Ⅰ和40.7%(11/27)ant(3″)-Ⅰ氨基糖苷类修饰酶基因阳性。MLST分析有9种序列类型,依次为ST37(40.7%)、ST11(40.7%)、ST1(11.1%)、ST789(11.1%)、ST15(7.4%)、ST147(7.4%)、ST76(3.7%)、ST722(3.7%)和ST290(3.7%)。29.6%(8/27)的标本分布在ICU重症监护病房,18.5%(5/27)的标本分布在神经内科病房。51.9%(14/27)标本来源于痰液,37.04%(10/27)标本来源于尿液。结论院内发生过ST11型产16S rRNA甲基化酶基因rmtB阿米卡星肺炎克雷伯菌的克隆流行株。肺炎克雷伯菌对阿米卡星耐药与携带rmtB和aac(6′)-Ⅰ氨基糖苷类耐药基因关系密切。Objective To study the genetics relationship among clinical isolates of Klebsiella pneumoniae and the prevalence and sources of aminoglycoside resistant genes,as to provide evidence for clinical infection control.Methods Walkaway 96 plus automatic bacterial identification and drug sensitivity analyzer were used.Twenty-seven strains of amikacin-resistant Klebsiella pneumonia isolated from June 2013 to November 2014 were identified and tested.The susceptibility of some antimicrobial agents was detected by disk diffusion and E-test,and aminoglycoside resistance genes were detected by polymerase chain reaction(PCR).Some positive genes were sequenced.Multilocus sequence typing(MLST)was used to identify the genetic relationship among the strains.Results Among the 27 strains,88.9%(24/27)isolates harbored the 16S rRNA methylase gene rmtB.The positive rates of the aminoglycoside modifying enzyme gene aac(3)-II,aac(6′)-I and ant(3″)-I were 51.9%(14/27),40.7%(11/27),and 40.7%(11/27),respectively.MLST analysis revealed nine sequence types(STs),which were ST37(40.7%),ST11(40.7%),ST1(11.1%),ST789(11.1%),ST15(7.4%),ST147(7.4%),ST76(3.7%),ST722(3.7%)and ST290(3.7%).29.6%(8/27)specimens were found in ICU,and 18.5%(5/27)were from neurology ward.The bacterial strains were mainly isolated from sputum and urine,accounting for 51.9%(14/27)and 37.04%(10/27),respectively.Conclusions The amikacin-resistant Klebsiella pneumonia strains belonging to ST11 spread in hospital;and these isolates harbored the rmtB gene.The drug-resistance of Klebsiella pneumoniae to amikacin is closely associated with rmtB and aac(6′)-I.

关 键 词：耐阿米卡星 肺炎克雷伯菌 氨基糖甙类耐药基因 多位点序列分型 

分 类 号：R446.5[医药卫生—诊断学]