医院获得性肺炎分离产ESBLs肺炎克雷伯菌株基因分型和耐药性特征  

Genotypes and drug resistance characteristics of ESBLs-producing Klebsiella pneumoniae isolated from patients with hospital-acquired pneumonia

作　　者：王纳 宋海宁 左秋琳 王永斌 韩雪梅 WANG Na;SONG Hai-ning;ZUO Qiu-lin;WANG Yong-bin;HAN Xue-mei(Qingdao Traditional Chinese Medicine Hospital(HaiciHospital),Qingdao,Shandong 266033,China)

机构地区：[1]青岛市中医医院(市海慈医院)呼吸与急危重症中心,山东青岛266033 [2]青岛市中医医院(市海慈医院)消化科,山东青岛266033

出　　处：《中华医院感染学杂志》2022年第21期3224-3228,共5页Chinese Journal of Nosocomiology

基　　金：山东省科研基金资助项目(2019J68)。

摘　　要：目的探讨医院获得性肺炎分离产β-内酰胺酶(ESBLs)肺炎克雷伯菌的基因分型及耐药性特征。方法选择2018年2月-2021年3月青岛市中医医院临床分离鉴定的80株肺炎克雷伯菌,均分离自医院获得性肺炎感染患者。进行ESBLs分型,采用纸片法进行抗菌药物敏感性试验;采用聚合酶链式反应分析CTX-M-1、CTX-M-2、CTX-M-9、TEM、SHV等基因类型。结果80株肺炎克雷伯菌共检出产ESBLs肺炎克雷伯菌44株,检出率为55.0%;耐药性分析提示产ESBLs肺炎克雷伯菌对氨苄西林、头孢唑林、头孢噻肟、头孢曲松、头孢呋辛、左氧氟沙星、环丙沙星、阿米卡星耐药性较高;对亚胺培南、美罗培南敏感性较高。产ESBLs肺炎克雷伯菌对头孢唑林、头孢噻肟、头孢曲松、左氧氟沙星、环丙沙星、阿米卡星等药物耐药性高于非产ESBLs肺炎克雷伯菌(P<0.05)。入组产ESBLs肺炎克雷伯菌SHV、TEM、CTX-M-1基因扩增阳性率分别为68.18%(30/44)、40.91%(18/44)、50.00%(22/44),其中未检出基因SHV、TEM、CTX-M-1基因扩增菌株1株(2.27%),同时携带2、3种耐药基因的菌株分别占比38.64%(17/44)、15.91%(7/44)。结论产ESBLs菌株在肺炎克雷伯菌中检出率较高,且对常见抗菌药物耐药情况较为严重,部分呈现多药耐药现象,在临床应合理使用抗菌药物并进行耐药特征的监测。OBJECTIVE To explore the genotypes and drug resistance characteristics of extended-spectrumβ-lactamases(ESBLs)-producing Klebsiella pneumoniae isolated from patients with hospital-acquired pneumonia(HAP).METHODS Totally 80 strains of K.pneumoniae were isolated from Qingdao Traditional Chinese Medicine Hospital from Feb 2018 to Mar 2021,all of the strains were isolated from the patients with HAP.ESBLs genotyping was carried out,the drug susceptibility testing was performed by Kirby-Bauer method,and the genotypes of CTX-M-1,CTX-M-2,CTX-M-9,TEM,and SHV were analyzed by polymerase chain reaction.RESULTS Totally 44 strains of ESBLs-producing K.pneumoniae were detected among 80 strains of K.pneumoniae,with the detection rate 55.0%.The analysis of drug resistance showed that the ESBLs-producing K.pneumoniae strains were highly resistant to ampicillin,cefazolin,cefotaxime,ceftriaxone,cefuroxime,levofloxacin,ciprofloxacin and amikacin but were highly sensitive to imipenem and meropenem.The drug resistance rates of the ESBLs-producing K.pneumoniae to cefazolin,cefotaxime,ceftriaxone,levofloxacin,ciprofloxacin and amikacin were higher than those of the non-ESBLs-producing K.pneumoniae(P<0.05).The positive rates of amplification of SHV,TEM and CTX-M-1 genes were respectively 68.18%(30/44),40.91%(18/44)and 50.00%(22/44)among the ESBLs-producing K.pneumoniae,1(2.27%)strain without SHV,TEM and CTX-M-1 genes being amplified was detected,the strains carrying with 2 types of drug resistance genes accounted for 38.64%(17/44),and the strains carrying with 3 types of drug resistance genes accounted for 15.91%(7/44).CONCLUSION The isolation rate of ESBLs-producing strains is high among the K.pneumoniae strains,the strains are highly resistant to the commonly used antibiotics,and some of the strains are multidrug-resistant.It is necessary for the hospital to reasonably use antibiotics and monitor the characteristics of drug resistance.

关 键 词：医院获得性肺炎 肺炎克雷伯菌 Β-内酰胺酶 耐药性 耐药基因 

分 类 号：R378.996[医药卫生—病原生物学]