ICU感染患者分离肺炎克雷伯菌AmpC酶、ESBLs基因检测及耐药性  

AmpC enzyme and ESBLs genes in Klebsiella pneumoniae strains isolated from ICU patients with infection and drug resistance

作　　者：喻茂文 孙玉燕 童贤利 罗莉茹 郭静 YU Mao-wen;SUN Yu-yan;TONG Xian-li;LUO Li-ru;GUO Jing(Jintang Hospital,West China Hospital,Sichuan University,Chengdu,Sichuan 610400,China)

机构地区：[1]四川大学华西医院金堂医院检验科,四川成都610400

出　　处：《中华医院感染学杂志》2023年第6期806-810,共5页Chinese Journal of Nosocomiology

基　　金：国家高技术研究发展计划(863计划)子课题(2014AA022304)。

摘　　要：目的 研究重症监护室(ICU)感染患者分离的肺炎克雷伯菌头孢菌素(AmpC)酶、超广谱β-内酰胺酶(ESBLs)基因检测情况,并分析耐药性。方法 选取2016年4月-2020年4月四川大学华西医院金堂医院ICU医院感染患者临床分离的498株肺炎克雷伯菌株,进行细菌分离与鉴定、AmpC酶耐药表型与基因型分析、接合转移试验,选出AmpC酶菌株并确证,聚合酶链式反应(PCR)、DNA测序分析AmpC酶基因型,同时进行药敏试验。结果 498株肺炎克雷伯菌株主要来自痰液(78.31%),共筛选出疑产AmpC酶阳性菌株102株,初筛阳性率20.48%,经接合试验、AmpC酶三维试验确证获得50株产AmpC接合子,产AmpC酶检出率49.02%(50/102);经基因测序单纯AmpC酶基因阳性菌株32株(64.00%),同时携带AmpC酶及ESBLs基因菌株18株(36.00%),DNA测序证实均为DHA-1型AmpC酶。>60岁人群产AmpC酶肺炎克雷伯菌检出率高于其他年龄段人群(P<0.05);同产ESBLs+AmpC酶的肺炎克雷伯菌耐药率高于单产AmpC酶(除头孢唑林、头孢呋辛、阿莫西林/克拉维酸外),总耐药率中,对头孢唑林与头孢呋辛、阿莫西林/克拉维酸等的耐药率在68.00%~100.00%,对厄他培南、美罗培南、亚胺培南敏感。结论 ICU医院感染患者临床分离的肺炎克雷伯菌AmpC酶及ESBLs+AmpC酶检出率高,后者耐药性尤其严峻,临床需合理使用抗菌药物。OBJECTIVE To explore the cephalosporinase(AmpC enzyme) and extended-spectrum β-lactamases(ESBLs) genes in Klebsiella pneumoniae strains isolated from intensive care unit(ICU) patients with infection and observe the drug resistance. METHODS Totally 498 strains of K.pneumoniae were isolated from ICU patients with nosocomial infection in Jintang Hospital, West China Hospital, Sichuan University from Apr 2016 to Apr 2020. The strains were isolated and identified, drug resistance phenotypes and genotypes of AmpC enzyme were analyzed, conjugational transfer test was carried out, AmpC enzyme-producing strains were screened out and confirmed, the genotypes of AmpC enzyme were detected by polymerase chain reaction and DNA sequencing, and the drug susceptibility testing was performed. RESULTS Among the 498 strains of K.pneumoniae, 78.31% were isolated from sputum specimens. Totally 102 strains of suspected AmpC enzyme-positive isolates were screened out, with the positive rate of primary screening 20.48%. Totally 50 strains of AmpC-producing conjugants were obtained by conjugational transfer test and AmpC enzyme three-dimensional confirmatory test, with the detection rate of AmpC enzyme 49.02%(50/102). The result of gene sequencing showed that 32(64.00%) strains were tested positive for simple AmpC enzyme gene, 18(36.00%) strains carried with both AmpC enzyme and ESBLs genes. DNA sequencing confirmed that all the strains produced DHA-1 type AmpC enzyme. The isolation rate of AmpC enzyme-producing K.pneumoniae was higher in the population aged more than 60 years old than in the population of other age groups(P<0.05). The drug resistance rates of ESBLs+AmpC enzyme-producing K.pneumoniae strains were higher than those of the strains that only produced AmpC enzyme(except for cefazolin, cefuroxime, amoxacillin-clavulanic acid). The drug resistance rates to cefazolin, cefuroxime and amoxacillin-clavulanic acid ranged between 68.00% and 100.00%, and the strains were sensitive to ertapenem, meropenem and imipenem. CONCLUSION The

关 键 词：重症监护室 肺炎克雷伯菌 头孢菌素酶 超广谱Β-内酰胺酶 耐药性 

分 类 号：R378.996[医药卫生—病原生物学]