碳青霉烯类耐药肺炎克雷伯菌脓毒症患者分离株CRKPⅠ类整合子和插入序列共同区分布  

Distribution of class I integrons and insertion sequence common region in carbapenem-resistant Klebsiella paeumoniae isolates from sepsis patients

作　　者：李华[1] 牛小斌[2] 胡玥[2] 胡仕祥[1] 李琰[1] 臧宾宾[1] 王坤 徐晓婷 LI Hua;NIU Xiao-bin;HU Yue;HU Shi-xiang;LI Yan;ZANG Bin-bin;WANG Kun;XU Xiao-ting(Henan Province Hospital of TCM,Zhengzhou,Henan 45oo02,China)

机构地区：[1]河南省中医院急救创伤中心,河南郑州450002 [2]河南省中医院检验科,河南郑州450002

出　　处：《中华医院感染学杂志》2023年第5期677-682,共6页Chinese Journal of Nosocomiology

基　　金：河南省科技攻关计划基金资助项目(21A320009)。

摘　　要：目的分析碳青霉烯类耐药肺炎克雷伯菌(CRKP)脓毒症患者分离株Ⅰ类整合子、插入序列共同区(ISCR)分布情况。方法选择2020年1月-2021年1月河南省中医院重症监护病房(ICU)收治的脓毒症患者60例,分离非重复CRKP菌株51株,采用全自动微生物鉴定仪行菌株鉴定和药敏试验,聚合酶链式反应(PCR)检测耐药基因及CRKPⅠ类整合子、ISCR分布情况。结果51株CRKP菌株对碳青霉烯类完全耐药,对β-内酰胺类耐药率>85%,对替加环素和多黏菌素B具有较高敏感性,耐药率分别为9.80%和7.84%;KPC-2基因阳性菌株51株,阳性率为100.00%,SHV基因阳性菌株49株(96.08%),CTX-M9基因阳性菌株36株(70.59%),NDM-1基因阳性菌株6株(11.76%),CTX-M1基因阳性菌株2株(3.92%),未检出VIM、IMP、OXA48及GES阳性菌株;检出Ⅰ类整合子阳性42株(82.35%),其中可变区阳性38株(74.51%),携带耐药基因aadA2和aadA5,检出ISCR阳性5株(9.80%),其中可变区1株,携带耐药基因sul1,检出同时携带Ⅰ类整合子和ISCR菌株3株。结论脓毒症患者分离的51株CRKP菌株均携带KPC-2基因,同时携带其他耐药基因,CRKP菌株中Ⅰ类整合子分布广泛,ISCR分布较少,二者以串联形式存在并可能造成耐药基因在不同CRKP克隆株之间水平传播,从而导致CRKP菌株耐药的复杂性以及多样性。OBJECTIVE To analyze the distribution of classⅠintegrons and insertion sequence common region(ISCR)in carbapenem-resistant Klebsiella pneumoniae(CRKP)isolates from patients with sepsis.METHODS A total of 60 sepsis patients who were treated in intensive care unit(ICU)of Henan Province Hospital of TCM from Jan 2020 to Jan 2021 were enrolled in the study,51 strains of non-repetitive CRKP were isolated,the strains were identified by using automatic microorganism identification system,the drug susceptibility testing was carried out.The drug resistance genes,class integrons and ISCR of the CRKP strains were detected by means of polymerase chain reaction(PCR).RESULTS All of the 51 strains of CRKP were completely resistant to carbapenems,the drug resistance rate toβ-lactams was more than 85%,and the drug resistance rates to tigecycline and polymyxin B were 9.80%and 7.84%,respectively.51 strains were tested positive for KPC-2 gene,with the positive rate 100.00%;49(96.08%)strains were tested positive for SHV gene,36(70.59%)strains were tested positive for CTX-M9 gene,6(11.76%)strains were tested positive for NDM-1 gene,2(3.92%)were tested positive for CTX-M1 gene,and no strains were tested positive for VIM,IMP,OXA48 or GES.A total of 42(82.35%)strains were tested positive for classⅠintegrons,38(74.51%)of which were positive for variable region and carried with drug resistance genes aadA2 and aadA5;5(9.80%)strains were tested positive for ISCR,1 of which was variable region and carried with drug resistance gene sul1;3 strains carried with both typeⅠintegrons and ISCR.CONCLUSION All of the 51 strains of CRKP that are isolated from the sepsis patients carry with KPC-2 gene and other drug resistance genes.The classⅠintegrons are widely distributed in the CRKP strains,and ISCR is less distributed.Th tandem existence of the two may result in the horizontal transmission of drug resistance genes among the CRKP clone strains,which leads to the complexity and diversity of the drug resistance of the CRKP strains.

关 键 词：脓毒症 碳青霉烯类耐药肺炎克雷伯菌 整合子 插入序列共同区 耐药基因 分布 分子流行病学 

分 类 号：R378.996[医药卫生—病原生物学]