医院碳青霉烯耐药肺炎克雷伯菌的耐药特征分析  

Antibiotic resistance characteristics of carbapenem-resistant Klebsiella pneumoniae

作　　者：孙胜君 张昌莲[2] 赵自云 SUN Sheng-jun;ZHANG Chang-lian;ZHAO Zi-yun(Clinical Laboratory,Yantai Yantai Mountain Hospital,Yantai 264000,China)

机构地区：[1]烟台市烟台山医院检验科,山东烟台264000 [2]山东省荣成市人民医院输血科,山东荣成264300 [3]青岛市中心医院检验科,山东青岛266042

出　　处：《中国实验诊断学》2022年第4期515-518,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的 分析碳青霉烯耐药肺炎克雷伯菌的耐药表型和基因型等特征,为临床抗感染治疗提供实验依据。方法 收集2017年5月至2021年4月间住院患者感染性标本中分离的碳青霉烯耐药肺炎克雷伯菌,采用VITEK-2compact全自动细菌鉴定/药敏分析系统对碳青霉烯耐药菌株进行鉴定和药敏试验,应用SPSS Statistics 17.0软件进行耐药率差异分析。结果 共获得碳青霉烯耐药肺炎克雷伯菌55株,耐药菌株来源于痰液标本31株、尿液标本14株、血液标本10株;药敏结果显示:受试菌株均对美罗培南和亚胺培南耐药且对9种β-内酰胺类药物的耐药率均达到98.2%以上。碳青霉烯耐药肺炎克雷伯菌对多数抗菌药物的耐药率均在50%以上且多重耐药菌株高达81.8%,其中以β内酰胺类、氨基糖苷类、氟喹诺酮类、复方新诺明四类耐药最为流行。不同类型标本来源的菌株对多数抗菌药物的耐药率并无显著性差异。55株菌株中均检测到碳青霉烯耐药基因,其中blaKPC-2检出率为90.9%,blaNDM为9.1%。受试菌株呈现10余种MLST型,其中以ST11和ST23型最为流行。结论 引起医院内感染的碳青霉烯耐药肺炎克雷伯菌多重耐药严重,MLST分型以ST11和ST23型为主,碳青霉烯耐药主要是由blaKPC-2和blaNDM引起的。Objective To analyze the phenotypic and genetic characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP)and provide experimental basis for clinical anti-infection treatment.Methods Clinical CRKP isolates were collected from infectious specimens of hospitalized patients between May 2017to Apr 2021,VITEK-2compact automatic bacterial identification/antibiotic susceptibility sensitivity system was used for identification and antibiotic sensitivity test of the clinically isolated CRKP strains.SPSS Statistics 17.0was used to analyze the difference of drug resistance rate.Results A total of 55CRKP isolates were collected,consisting of 31from Sputum specimens,14from urine specimens and 10from blood specimens.The results of drug sensitivity test showed that all the tested strains were resistant to Meropenem and Imipenem,and the drug resistance rates to 9β-lactam drugs were more than 98.2%.The drug resistance rates of Carbapenem-resistant Klebsiella pneumoniae to most drugs were more than 50%and the multiple drug resistance strains were as high as 81.8%,among whichβ-lactamides,aminoglycoside,fluoroquinolones,cotrimoxazole were the most popular.The antibiotic resistance rates to most drugs of isolates from different specimens showed no significant difference.Carbapenem resistance gene was detected in 55strains,of which the detection rate of blakpc-2 was 90.9% and blaNDM was 9.1%.Above 10types of MLST were found among the CRKP isolates and the predominant types were ST11and ST23.Conclusion Most CRKP isolates causing nosocomial infection showed multi-drug resistance.ST11and ST23types of MLST were the two most predominant types of CRKP.The carbapenem-resistance among these CRKP isolates were mediated by resistance genes blaKPC-2andblaNDM.

关 键 词：肺炎克雷伯菌 碳青霉烯耐药 多重耐药 耐药基因 

分 类 号：R378.996[医药卫生—病原生物学]