成都市碳青霉烯类耐药肺炎克雷伯菌表型分析  

Phenotypes of CRKP in Chengdu

作　　者：杨莉莉[1] 刘敏[1] 梁树梅 冯小艳[1] 张峻梅[1] 彭溪[1] 杨菊艳 Yang Lili;Liu Min;Liang Shumei;Feng Xiaoyan;Zhang Junmei;Peng Xi;Yang Juyan(Laboratory Department,the Third People's Hospital of Chengdu,the Second Affiliated Chengdu Clinical College of Chongqing Medical University,Chengdu,Sichuan,610031,China)

机构地区：[1]四川省成都市第三人民医院暨重庆医科大学附属成都第二临床学院检验科,成都610031

出　　处：《西南国防医药》2020年第6期552-554,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的研究碳青霉烯类耐药肺炎克雷伯菌(CRKP)的耐药基因分布情况,为成都地区CRKP研究提供参考依据.方法收集2014年2月~2018年6月成都市第三人民医院临床分离的282株CRKP,采用全自动微生物鉴定仪进行细菌鉴定及药物敏感试验;改良Hodge试验筛查菌株碳青霉烯酶;聚合酶链反应(PCR)及Sanger测序检测菌株碳青霉烯酶耐药基因;经脉冲凝胶电泳(PFGE)对CRKP进行分子分型及分析.结果282株CRKP感染患者临床按症状分布以重症肺炎29.08%(82/282)、慢性阻塞性肺疾病15.96%(45/282)、肺部感染12.06%(34/282)为主;改良Hoged实验阳性率为87.9%;耐药基因测序结果显示blaKPC、blaIMP、blaNDM分别占比为89.5%、4.2%、6.3%;脉冲凝胶电泳显示,282株菌包含了68个不同的PFGE型别,其中A型包含101株.结论2014~2018年成都地区分离得到的CRKP以携带KPC基因为主,共有68个型别,以A型(35.8%)为主,CRKP分子型别多样性大,但同时存在优势带型,提示社区获得性和医院获得性并存.Objective To study the genotyping of drug resistance genes of carbapenem-resistant Klehsiella pneumonia(CRKP)in Chengdu.Methods A total of 282 CRKP isolates in the Third People's Hospital of Chengdu from February 2014 to June 2018 were collected.The MicroScan WalkAway automated bacterial identification and susceptibility testing system was used to identify bacteria and test drug sensitivity.Modified Hodge test used adopted to test carbapenemases in the strains.Polymerase chain reaction(PCR)and Sanger sequencing were performed to test the drug resistance genes of carbapenemases in the strains.Pulse field gel electrophoresis(PFGE)was employed for molecular typing and analysis of CRKP.Results Severe pneumonia(82/282,29.08%),chronic obstructive pulmonary disease(COPD,45/282,15.96%)and pulmonary infection(34/282,12.06%)were the main clinical findings among 282 patients infected with CRKP.The positive rate of modified Hodge test was 87.9%.The drug resistance gene sequencing showed 89.5%,4.2%and 6.3%of blaKPC,blaIMP and blaNDM respectively.PFGE revealed that the 282 strains consisted of 68 PFGE types,including 101 strains of type A.Conclusion The main gene in CRKP isolates in Chengdu between 2014 and 2016 is KPC.The stains consist of 68 types,among which 35.8%are type A.The molecular types of CRKP are diverse,but there are dominant banding pattern,suggesting the coexistence of community-acquired and hospital-acquired infection.

关 键 词：肺炎克雷伯菌 耐碳青霉烯类 耐药基因分布 同源性 

分 类 号：R[医药卫生]