产KPC铜绿假单胞菌的耐药分子机制及其临床分布  

Molecular mechanism and clinical distribution of drug resistance of pseudomonas aeruginosa KPC

作　　者：陈勇[1] 史利宁[1] 胡毓安[1] 曹进[1] 孙宁[1] 姚新月 张静[1] 王颖[1] 范明[1] 王卫萍[1] CHEN Yong;SHI Li-ning;HU Yu-an;CAO Jin;SUN Ning;YAO Xin-yue;ZHANG Jing;WANG Ying;FAN Ming;WANG Wei-ping(Basic Medical Laboratory,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)基础医学实验室,南京210002

出　　处：《医学研究生学报》2021年第6期575-579,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81601857)。

摘　　要：目的产KPC铜绿假单胞菌(PA)常为泛耐药菌,增加了临床治疗的难度。探讨产KPC的PA的分子耐药传播机制及其临床分布,为预防和控制耐药菌株的传播以及临床治疗提供理论依据。方法收集东部战区总医院2018年7月至2018年12月临床分离的泛耐药PA,16S rRNA测序法进行菌种鉴定;改良CarpaNP法检测碳青霉烯酶的类型;PCR法进行碳青霉烯酶基因检测和质粒同源性分析;高通量全基因组测序技术对其质粒进行测序。结果112株泛耐药PA中有20株菌检出A类碳青霉烯酶,占17.9%,经PCR验证均携带bla KPC基因。其中16株来自ICU病房,占80.0%。质粒全序测定结果显示,质粒全长51.6 kb,有69个开放阅读框(ORFs),平均GC含量59.2%,是一个全新的带bla KPC质粒,它有全新的骨架区和1个新的Tn 1403-based bla KPC-2单元转座子。结论产KPC酶是PA对碳青霉烯类药物耐药的重要原因,PA中出现携带bla KPC-2的耐药质粒,提示这种耐药特性将如同其在肠杆菌科一样在PA中播散。Objective Pseudomonas aeruginosa producing KPC is often pan-drug resistant,which increases the difficulty of clinical treatment.The molecular mechanism and clinical distribution of drug resistance of Pseudomonas aeruginosa KPC for the prevention and control of drug-resistant strains the dissemination and clinical treatment were investigated in this study to provide a theoretical basis.Methods The pan-drug resistant Pseudomonas aeruginosa were collected from July 2018 to December 2018,which were identified by 16S rRNA sequencing method.Identification of carbapenemase was modified CarpaNP method.Carbapenemase genes were determined by PCR followed by amplicon sequencing and were analyzed homologously.The plasmid was sequenced by high throughput whole genome sequencing technology.Results Among 112 strains of pan-drug resistant Pseudomonas aeruginosa,20 strains(17.9%)were detected carbapenemases of class A carbapenemase.bla KPC genes were determined all by PCR followed by amplicon sequencing.Among them,the 16 strains(80.0%)were from ICU.The whole sequence of the plasmid showed that the length of the plasmid was 51.6 kb with 69 open reading frames and the average of GC content was 59.2%.It was a new plasmid with bla KPC,which has new framework region and a new element transposon of Tn 1403-based bla KPC-2..Conclusion The production of KPC enzyme is an important reason for the resistance of Pseudomonas aeruginosa to carbapenems.The presence of bla KPC-2 resistant plasmids in Pseudomonas aeruginosa shows that the kind of drug-resistance character is disseminated among Pseudomonas aeruginosa like Enterobacteriaceae.

关 键 词：铜绿假单胞菌 bla_(KPC-2) 碳青霉烯酶 

分 类 号：R37[医药卫生—病原生物学]