某院耐碳青霉烯肺炎克雷伯菌耐药机制及医院传播  

Drug resistance mechanisms of carbapenem-resistant Klebsiella pneumoniae and its transmission in a hospital

作　　者：毛璞[1] 颜乐平 单靖岚[1] 张容[2] 李常安[1] 梁素媚 刘晓青[2] 黎毅敏[2] 叶丹[1] MAO Pu;YAN Le-ping;SHAN Jing-lan;ZHANG Rong;LI Chang-an;LIANG Su-mei;LIU Xiao-qing;LI Yi-min;YE Dan(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,China;不详)

机构地区：[1]广州医科大学附属第一医院医院感染管理科,广东广州510120 [2]广州医科大学附属第一医院医院重症医学科,广东广州510120

出　　处：《中华医院感染学杂志》2021年第20期3110-3114,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81770077,81700080)。

摘　　要：目的探讨某院耐碳青霉烯肺炎克雷伯菌(CRKP)的同源性、耐药机制及医院传播。方法回顾性分析2016-2019年广州医科大学附属第一医院肺炎克雷伯菌(KPN)以及CRKP的检出情况,收集2019年1-12月医院85株CRKP,分析科室来源及药敏情况,利用聚合酶链反应(PCR)法检测碳青霉烯酶基因,运用脉冲场凝胶电泳技术(PFGE)进行同源性分析。结果 2019年CRKP的分离率较2016年、2017年、2018年相比增加(P<0.001),2019年85株CRKP主要来源于重症医学科(ICU)为48株占比56.47%,对包括厄他培南、美罗培南、亚胺培南在内的多种抗菌药物耐药率达90%以上。碳青霉烯酶基因blaKPC-2、blaNDM-1和blaIMP-4阳性率分别为78.82%、5.88%和2.35%,孔膜蛋白blaOmpK-35、blaOmpK-36和blaOmpK-37基因缺失率分别为5.88%、94.12%和7.06%,blaKPC-2合并blaOmpK-36缺失的菌株达77.65%。PFGE分析发现85株CRKP分属A~O共15个克隆型,涉及57株菌占比67.06%,其余为散发,其中涉及菌株最多的克隆型为H型和I型,分别包括8株和9株。结论产KPC酶及孔膜蛋白基因blaOmpK-36的缺失是医院CRKP的主要耐药机制,医院流行可能是CRKP分离率升高的主要原因;其中ICU与呼吸科是CRKP聚集的主要场所,应重点加强ICU与呼吸科的防控措施,减少医院感染的发生与传播。OBJECTIVE To explore the homology,drug resistance mechanisms and transmission of carbapenem-resistant Klebsiella pneumoniae(CRKP) in a hospital.METHODS The isolation rates of K.pneumoniae and CRKP in the First Affiliated Hospital of Guangzhou Medical University from 2016 to 2019 were retrospectively analyzed,85 strains of CRKP were isolated from the hospital from Jan.2019 to Dec.2019,the distribution of the strains in departments and drug susceptibility rates were observed,the carbapenemase genes were detected by using polymerase chain reaction(PCR),and the homology of the strains was analyzed by means of pulsed field gel electrophoresis(PFGE).RESULTS The isolation rate of CRKP was significantly higher in 2019 than in 2016,2017 and 2018(P<0.001).Among the 85 strains of CRKP isolated from 2019,48(56.47%) were isolated from intensive care unit(ICU),the drug resistance rates to ertapenem,meropenem and imipenem were more than 90%.The positive rates of carbapenemase genes blaKPC-2,blaNDM-1 and blaIMP-4 were respectively 78.82%,5.88% and 2.35%,the miss rates of pore membrane protein blaOmpK-35,blaOmpK-36 and blaOmpK-37 genes were respectively 5.88%,94.12% and 7.06%,the strains lacking blaKPC-2 and blaOmpK-36 accounted for 77.65%.PFGE analysis showed that 85 strains were classified into 15 clone types(A-O),involving 57 strains(67.06%),and the rest were sporadic.The H and I clones included 8 and 9 strains of CRKP,respectively.CONCLUSION The production of KPC-2 enzyme and deletion of Ompk-36 gene are the major drug resistance mechanisms of the CRKP,the nosocomial prevalence may be the leading cause of increase of isolation rate of CRKP,the CRKP strains are most prevalent in ICU and respiratory department.It is necessary to take prevention and control measures particularly in ICU and respiratory department so as to reduce the incidence and transmission of nosocomial infection.

关 键 词：肺炎克雷伯菌 碳青霉烯酶基因 耐药机制 脉冲场凝胶电泳 医院传播 

分 类 号：R378.996[医药卫生—病原生物学]