耐碳青霉烯类肺炎克雷伯菌耐药性及耐药基因的研究  

The investigation and study of drug resistance and drug resistance genes of CRKP

作　　者：杨燕文[1] 吴梦莹 韩鹏鹏 陶佳 周晓燕 李刚 YANG Yan-wen;WUMeng-ying;HAN Peng-peng

机构地区：[1]宁夏医科大学总医院神经内科,宁夏银川750004 [2]宁夏医科大学总医院医学实验中心,宁夏银川750004 [3]宁夏医科大学心脑血管病医院检验科,宁夏银川750000

出　　处：《中国医学装备》2020年第1期118-121,共4页China Medical Equipment

摘　　要：目的:研究耐碳青霉烯肺炎克雷伯菌(CRKP)的耐药性及耐药基因类型,为合理使用抗菌药物及监测院内感染等提供有效的科学指导。方法:对医院收治的肺炎患者分离出的29株CRKP,采用改良碳青霉烯类失活(mCIM)试验法检测肺炎克雷伯菌中的碳青霉烯酶,通过聚合酶链反应(PCR)及测序方法对碳青霉烯酶基因KPC、IMP、NDM型、超广谱β内酰胺酶基因(ESBLs)、TEM、SHV、CTX-M型以及AmpC酶基因DHA进行检测。结果:29株耐药菌株对大部分临床常用抗菌药物高度耐药,对氟喹诺酮类抗菌药物和氨基糖苷类抗菌药物有较高的敏感性。表型确认试验中7株改良Hodge实验阳性,18株mCIM试验阳性。20株(占68.97%)菌检测到碳青霉烯酶基因,其中KPC为17.24%(5/29),IMP为13.79%(4/29),NDM为37.93%(11/29)。25株(占86.20%)菌检测到ESBLs菌株的基因,其中TEM型为62.07%(18/29),SHV型为79.31%(23/29),CTX-M型为62.07%(18/29)。3株菌检测到AmpC酶基因,其中DHA为10.34%(3/29)。29株CRKP中有14株既表达了碳青霉烯酶基因又表达了ESBLs的基因,共同表达率为48.28%。对耐药基因抽取其中部分阳性结果进行测序后均为目标基因,其中KPC为KPC-2、NDM为NDM-1。结论:29株CRKP对多种抗生素耐药率均较高,且对碳青霉类抗菌药物的耐药基因型主要为KPC-2和NDM-1,故加强院内感染预防控制措施,防止此类菌株的播散。Objective:To investigate and study the drug resistance and drug resistance genes of Carbapenem-resistant Klebsiella pneumoniae(CRKP)so as to provide effectively scientific guidance for rational using antibacterial agents and monitoring nosocomial infection.Methods:For 29 strains CRKP that were isolated from patients with pneumonia,the modified carbapenem inactivation method(mCIM)was adopted to detect carbapenemases of Klebsiella pneumonia.And polymerase chain reaction(PCR)and sequencing method were used to measure carbapenemases genes included KPC,IMP and NDM,and extended spectrumβ-lactamases(ESBLs)genes included TEM,SHV,CTX-M,and AmpC enzyme genes included DHA.Results:29 strains were highly resistant to common antibacterial drugs,and they had higher sensitivity to antibacterial drugs included fluoroquinolones and aminoglycosides.The phenotypic validation test showed that 7 strains were positive in the modified Hodge test and 18 strains were positive in mCIM test.And carbapenem genes was found in 20 stains(68.97%)involved KPC(5/29,17.24%),IMP(4/29,13.79%)and NDM(11/29,37.93%).ESBLs gene was detected in 25 strains(86.20%)involved TEM(18/29,62.07%),SHV(23/29,79.31%)and CTX-M(18/29,62.07%).Amp C enzyme gene was found in 3 strains included DHA(3/29,10.34%).Among 29 strains,14 strains expressed both carbapenem gene and ESBLs gene,and the common expression rate of them was 48.28%.Partial positive results of drug resistance gene were extracted to implement sequencing,and the results indicated that all of them were target genes,among which KPC was KPC-2 and NDM was NDM-1.Conclusion:29 strains CRKP have higher drug resistance rate to various antibiotics,and the drug resistance genotypes to carbapenems antibacterial agents are mainly KPC-2 and NDM-1.Measurement for preventing and controlling the nosocomial infection should be enhanced so as to avoid the dissemination of these kinds of strains.

关 键 词：耐碳青霉烯 肺炎克雷伯菌 耐药基因 耐药性 

分 类 号：R446.5[医药卫生—诊断学]