泰安市腹泻门诊病例粪便中肺炎克雷伯菌检出率、耐药特征和分子分型研究  

Detection rate, antimicrobial resistance and molecular types of Klebsiella pneumoniae from stool samples of outpatients with diarrhea-syndrome in Tai’an

作　　者：张新峰[1] 王蕾 胡彬[3] 张爱华[1] 郑金华[1] 陆娟娟[1] 毕振旺[3] Zhang Xinfeng;Wang Lei;Hu Bin;Zhang Aihua;Zheng Jinhua;Lu Juanjuan;Bi Zhenwang(Tai’an Prefectural Center for Disease Control and Prevention,Tai’an 271000,China;Jinan Second Center for Disease Control and Prevention,Jinan 271100,China;Shandong Provincial Center for Disease Control and Prevention,Jinan 250000,China)

机构地区：[1]泰安市疾病预防控制中心,271000 [2]济南市第二疾病预防控制中心,271100 [3]山东省疾病预防控制中心,济南250000

出　　处：《中华流行病学杂志》2020年第3期423-428,共6页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2012ZX10004-201-002)。

摘　　要：目的:了解泰安市感染性腹泻病门诊病例粪便中肺炎克雷伯菌的检出率、耐药特征及分子分型特性。方法:对采自泰安市6个县(市、区)2013-2017年腹泻病症候群监测病例的866份粪便标本进行肺炎克雷伯菌的分离培养和鉴定;采用微量肉汤稀释法研究分离菌株的耐药情况;应用PFGE技术对菌株进行分子分型。结果:肺炎克雷伯菌的总检出率为7.97%(69/866);各县(市、区)检出率差异有统计学意义(χ^2=39.627,P=0.000)。耐药菌株68株的15种常用抗生素的总耐药率为98.55%(68/69),对氨苄西林(AMP)和磺胺异恶唑(SOX)的耐药率最高,分别为84.06%(58/69)和72.46%(50/69),共有40个耐药谱,主要耐药谱特征为AMP-SOX(n=10);多重耐药率为33.33%(23/69)。69株分离株中共有65种PFGE型别,未发现优势带型或聚集现象。结论:肺炎克雷伯菌存在于泰安市各地区腹泻病症候群门诊病例的粪便中,能够引起社区获得性感染;对多种抗生素耐药,耐药谱广,多重耐药率高;PFGE带型呈现多样性,无耐药谱对应性。应高度重视和加强对该来源菌株的监测,防止更多的耐药菌株的产生和传播,保护易感人群。Objective To investigate the isolation rate,antimicrobial resistance phenotype,and molecular type characteristics of Klebsiella pneumoniae from infectious diarrhea outpatients in Tai’an.Methods A total of 866 stool samples were collected from infectious diarrhea cases in sentinel hospitals in 6 counties of Tai’an from 2013 to 2017.The strains were isolated from stool samples of the cases and identified by biochemical test.Micro broth dilution method was used to detect the drug resistance of the strains.The molecular typing was conducted by using pulsed field gel electrophoresis(PFGE).Results The detection rate of Klebsiella pneumoniae in the stool samples was 7.97%(69/866),with significant differences among the 6 counties(χ^2=39.627,P=0.000).Sixty-eight out of the 69 strains were resistant to 15 antibiotics with resistance rate 98.55%(68/69).The resistance to ampicillin(AMP)was highest(84.06%)(58/69),followed by sulfamethoxazole(SOX)(72.46%)(50/69).There were 40 drug resistance profiles,and the predominant resistance profile was AMP-SOX detected(n=10).The multi-drug resistant(MDR)strains accounted for 33.33%(23/69).The 69 strains could be divided into 65 PFGE patterns,and no predominant PFGE pattern or cluster was observed.Conclusions Klebsiella pneumoniae was detected in the stool samples of diarrhea-syndrome outpatients,indicating the risk for community-acquired infection;the strains were resistant to multiplex antibiotics,with wide drug-resistance profiles and high multi-drug resistance rates.The PFGE patterns were diverse,which showed no correlation with drug resistance profiles.Our study indicated that it necessary to strengthen the surveillance and detection of Klebsiella pneumoniae from diarrhea outpatients,which could facilitate the prevention of the emergence and spread of drug resistance strains and the protection of susceptible population.

关 键 词：腹泻 肺炎克雷伯菌 检出率 耐药性 脉冲场凝胶电泳 

分 类 号：R446[医药卫生—诊断学]