携带blaNDM-1耐药基因肺炎克雷伯菌的耐药性及分子流行特征研究  

Drug resistance and molecular epidemiological characteristics of Klebsiella pneumoniae carrying blaNDM-1 resistance gene

作　　者：王群[1,2] 叶梅毅 王芳 杨朝国[1] WANG Qun;YE Mei-yi;WANG Fang;YANG Chao-guo(Chengdu University of TCM,Chengdu,Sichuan 610000,China;不详)

机构地区：[1]成都中医药大学医学技术学院,四川成都611137 [2]大邑县人民医院检验科,四川成都611330 [3]四川省中医医院检验科,四川成都610075

出　　处：《现代预防医学》2020年第13期2426-2430,共5页Modern Preventive Medicine

摘　　要：目的了解耐碳青霉烯肺炎克雷伯菌(Carbapenem Resistant Klebsiella Pneum-oniae,CRKP)blaNDM基因的携带率、常用抗生素的耐药情况及分子流行特征,为临床CRKP感染治疗及防控提供理论依据。方法收集2016年1月至2018年9月四川省中医院临床分离的74株CRKP,采用Vitek 2 Compact仪器进行细菌鉴定及药敏试验,mCIM试验和eCIM试验进行B类金属酶表型确证;PCR扩增blaNDM基因并对阳性产物进行测序以确定基因型别;采用多位点序列分型技术(MLST)对产NDM酶菌株进行同源性分析。结果 PCR扩增及测序结果显示,74株CRKP中有8株携带blaNDM-1;携带blaNDM-1基因菌株药敏结果显示对试验的所有头孢菌素类、喹诺酮类抗生素为全耐药,仅对阿米卡星和替加环素敏感。74株CRKP的mCIM试验和eCIM试验的阳性率分别为98.65%和10.81%,8株产NDM酶菌株eCIM试验均阳性。MLST结果显示8株产NDM酶菌株均为ST307型。结论 CRKP菌株blaNDM-1携带率较高,耐药程度严重;ST307型CRKP可能更易捕获携带blaNDM-1的耐药质粒,医院应加强防控该类细菌的播散。Objective To understand the blaNDM gene carrier rate, drug resistance and molecular epidemic characteristics of common antibiotics for Carbapenem Resistant Klebsiella Pneumoniae(CRKP), so as to provide theoretical basis for clinical treatment and infection control. Methods 74 carbapenem-resistant Klebsiella pneumoniae(CRKP) isolated from January 2016 to September 2018 were collected, whose bacterial identification and antimicrobial susceptibility testing were performed by Vitek 2 Compact instrument, confirmation of Class B metalloenzyme phenotype was tested by mCIM test and eCIM test. The blaNDM gene was amplified by polymerase chain reaction(PCR) and the positive product was sequenced to determine the genotype. Homology analysis of NDM-producing Klebsiella pneumoniae was analyzed multilocus sequence typing(MLST). Results PCR amplification and sequencing showed that 8 of 74 strains of CRKP carried blaNDM-1 gene, and the carrying rate was 10.81%.The susceptibility of CRKP carrying the blaNDM-1 gene showed that full resistance to all cephalosporins, quinolones, and was only sensitive to amikacin and tigecycline.The positive rates of the mCIM test and eCIM test for CRKP strains were 98.65% and 10.81%, respectively. The blaNDM-1 positive strains eCIM test positive rate was 100%. The results of MLST showed that 8 strains of NDM-producing strains were all of type ST307.Conclusion The carrying rate of blaNDM-1 gene of CRKP strain is high, and the antibiotic resistance of NDM-producing bacteria is serious. ST307-type CRKP may be more likely to capture drug-resistant plasmids carrying the blaNDM-1 gene, and hospitals should strengthen prevention and control of the spread of such bacteria.

关 键 词：肺炎克雷伯菌 NDM型碳青霉烯酶 耐药性 多位点序列分型 

分 类 号：R117[医药卫生—公共卫生与预防医学]