下呼吸道分离高毒力肺炎克雷伯菌和经典肺炎克雷伯菌常见耐药基因检测以及耐药性比较分析  

Detection of Common Drug Resistance Genes and Comparative Analysis of Drug Resistance between Hypervirulent Klebsiella Pneumoniae and Classical Klebsiella pneumoniae Isolated from Lower Respiratory Tract

作　　者：吕承秀 王君君 李庆 LÜ Cheng-xiu;WANG Jun-jun;LI Qing(Department of Clinical Laboratory,the First Hospital of Zibo City,Shangdong Zibo 255200,China)

机构地区：[1]淄博市第一医院检验科,山东淄博255200

出　　处：《现代检验医学杂志》2022年第6期83-87,共5页Journal of Modern Laboratory Medicine

基　　金：山东省医药卫生科技发展计划项目(2018WS008)。

摘　　要：目的分析下呼吸道分离高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae,hvKP)和经典肺炎克雷伯菌(classical Klebsiella pneumoniae,cKP)常见耐药基因及耐药性比较分析,为临床抗感染治疗提供流行病学依据。方法收集2019年8月~2021年12月下呼吸道分离的200株非重复肺炎克雷伯菌菌株。用纸片扩散法(K-B法)进行菌株抗生素敏感试验,聚合酶链反应(polymerase chain reaction,PCR)检测菌株的毒力基因、耐药基因。采用毒力基因iucA,rmpA和peg-344均阳性的菌株定义为hvKP,其余菌株定义为cKP,比较分析hvKP和cKP的耐药性。结果200株肺炎克雷伯菌中,hvKP 91株,占比45.50%;cKP 109株,占比54.50%。hvKP和cKP耐药菌株中的超广谱β-内酰胺酶(extended spectrumβ-Lactamases,ESBLs)耐药基因均以blaSHV,blaTEM,blaCTX-1 group(1,3,15)为主要基因型,喹诺酮类耐药基因均以qnrS,acc(6’)-Ⅰb,qnrB为主要基因型。hvKP对头孢唑林、头孢呋辛、头孢噻肟、阿莫西林/克拉维酸、左氧氟沙星、环丙沙星和复方新诺明的耐药率均低于cKP,差异有统计学意义(χ^(2)=14.25,10.38,11.80,10.11,7.44,24.34,21.42,均P<0.05);qnrS基因在hvKP中的阳性率低于cKP,差异有统计学意义(χ^(2)=12.63,P=0.001)。结论下呼吸道分离hvKP与cKP耐药菌株中耐药基因主要基因型一致,但是hvKP对临床常用抗生素耐药率低于cKP,临床治疗应根据药敏结果合理应用抗生素。Objective To analyze the common drug resistance genes and drug resistance comparison between hypervirulent Klebsiella pneumoniae(hvKP)and classical Klebsiella pneumoniae(cKP)isolated from lower respiratory tract,and provide epidemiological basis for clinical anti-infection treatment.Methods 200 strains of Klebsiella pneumoniae isolated from lower respiratory tract from August 2019 to December 2021 were collected.The antimicrobial susceptibility test was carried out by disk diffusion method(K-B method),and the virulence genes and drug resistance genes were detected by polymerase chain reaction(PCR).The strains with positive virulence genes iucA,rmpA and peg-344 were defined as hvKP,and the other strains were defined as cKP.The drug resistance of hvKP and cKP were compared and analyzed.Results Among the 200 strains of Klebsiella pneumoniae,91 strains were hvKP,accounting for 45.50%,and cKP 109 strains,accounting for 54.50%.blaSHV,blaTEM and blaCTX-1group(1,3,15)were the main genotypes of extended spectrumβ-Lactamases(ESBLs)resistance genes in hvKP and cKP,and qnrS,acc(6’)-Ⅰb and qnrB were the main genotypes of quinolone resistance genes.The resistance rate of hvKP to Cefazolin,Cefuroxime,Cefotaxime,Amoxicillin/Clavulanic acid,Levofloxacin,Ciprofloxacin and Sulfamethoxazole were lower than that of cKP,and the differences were statistically significant(χ^(2)=14.25,10.38,11.80,10.11,7.44,24.34,21.42,all P<0.05).The positive rate of qnrS gene in hvKP was lower than that in cKP,the difference was statistically significant(χ^(2)=12.63,P=0.001).Conclusion The main genotypes of drug resistance genes in hvKP and cKP strains isolated from lower respiratory tract were the same,but the resistance rate of hvKP to common clinical antibiotics was lower than that of cKP,and antibiotics should be used reasonably according to the results of drug sensitivity.

关 键 词：高毒力肺炎克雷伯菌 经典肺炎克雷伯菌 耐药性 耐药基因 

分 类 号：R378.996[医药卫生—病原生物学] R446.5[医药卫生—基础医学]