耐碳青霉烯肺炎克雷伯菌的耐药分子学研究  

Molecular study of carbapenem-resistant Klebsiella pneumoniae resistance

作　　者：张晓慧[1] 王瑞雪[1] 高春艳[1] 侯辰蕊 宋静 戎建荣[1] ZHANG Xiaohui;WANG Ruixue;GAO Chunyan;HOU Chenrui;SONG Jing;RONG Jianrong(Department of Clinical Laboratory,Shanxi Academy of Medical Sciences,Shanxi Baiqiuen Hospital,Taiyuan,Shanxi 030032,China)

机构地区：[1]山西医学科学院·山西白求恩医院检验科,山西太原030032

出　　处：《国际检验医学杂志》2020年第11期1357-1361,共5页International Journal of Laboratory Medicine

基　　金：山西省自然科学基金项目(201601D011116)。

摘　　要：目的研究该院临床分离的耐碳青霉烯肺炎克雷伯菌的耐药分子学机制。方法分析该院临床微生物实验室分离的耐碳青霉烯肺炎克雷伯菌株(CRKP),采用基质辅助激光解析电离飞行时间质谱(MALDI-TOF MS)和全自动微生物分析仪(VITEK-2 compact)鉴定细菌并进行药物敏感试验分析,采用改良Hodge试验(MHT)和碳青霉烯酶灭活试验(CIM)进行表型确证;聚合酶链式反应(PCR)法检测碳青霉烯酶基因型,并进行基因测序BLAST比对和多位点序列分析(MLST)。结果46株耐碳青霉烯肺炎克雷伯菌对常用抗菌药物均表现出高耐药性;耐碳青霉烯表型确证均呈阳性,PCR检测结果显示其中包括A类碳青霉烯酶(KPC-2型)和B类金属酶(NDM-1和IMP-4),MLST分型以ST11型为主。结论该院分离的耐碳青霉烯肺炎克雷伯菌的耐药分子学机制主要以产KPC-2型碳青霉烯酶的ST11型为主,同时有少量其他型别的检出,加强院内感染监测强度和力度,以及进一步规范抗菌药的合理使用显得尤为重要。Objective To study the molecular mechanism of carbapenem-resistant Klebsiella pneumoniae clinically isolated in this hospital.Methods The carbapenem resistant Klebsiella pneumoniae(CRKP)isolated from the clinical microbiology laboratory of our hospital was analyzed.The bacteria were identified by matrix assisted laser desorption ionization time of flight mass spectrometry(MALDI-TOF MS)and full-automatic microbial analyzer(Vitek-2 compact)and drug sensitivity test was carried out,phenotype was confirmed by modified Hodge test(MHT)and carbapenem inactivation test(CIM).Carbapenem genotypes were detected by polymerase chain reaction(PCR),and gene sequencing blast comparison and multi site sequence analysis(MLST)were carried out.Results A total of 46 strains of carbapenem resistant Klebsiella pneumoniae showed high resistance to common antibiotics,and carbapenem resistant phenotypes were confirmed to be positive.PCR detection results showed that the carbapenem A(KPC-2 type)and B-type metal enzymes(NDM-1 and IMP-4)were included,and the MLST type was mainly ST11 type.Conclusion The molecular mechanism of carbapenem resistant Klebsiella pneumoniae isolated in our hospital is mainly ST11,which produces KPC-2 carbapenem,and a small number of other types are detected.It is particularly important to strengthen the intensity and intensity of hospital surveillance and further regulate the rational use of antibiotics.

关 键 词：耐碳青霉烯肺炎克雷伯菌 基因测序 多位点序列分析 

分 类 号：R446.5[医药卫生—诊断学]