重症医学科分离广泛耐药高毒力肺炎克雷伯菌XJ-K1与XJ-K2耐药特征、毒力因子及克隆分型  

Analysis of drug resistance characteristics,virulence factors and clonal typing of extensively drug-resistant and highly toxic Klebsiella pneumoniae XJ-K1 and XJ-K2 isolated from intensive care unit

作　　者：陈森 魏巍 刘杰 谌莹莹 郑翔[3] CHEN Sen;WEI Wei;LIU Jie;SHEN Ying-ying;ZHENG Xiang(Hubei University of Medicine,Shiyan,Hubei 442000,China;不详)

机构地区：[1]湖北医药学院临床技能教学培训中心,湖北十堰442000 [2]湖北医药学院第一临床学院,湖北十堰442000 [3]湖北医药学院附属太和医院重症医学科,湖北十堰442000

出　　处：《中华医院感染学杂志》2023年第7期961-965,共5页Chinese Journal of Nosocomiology

基　　金：湖北省卫生健康委青年人才项目(WJ2021F030)。

摘　　要：目的探讨重症科分离广泛耐药高毒力肺炎克雷伯菌XJ-K1与XJ-K2耐药特征、毒力因子及克隆分型。方法收集2019年1月-2021年12月湖北医药学院附属太和医院重症医学科分离的广泛耐药高毒力肺炎克雷伯菌XJ-K1与XJ-K2共121株。XJ-K1菌株来源于尿液标本(n=48),XJ-K2菌株来源于血液标本(n=73)。进行菌株培养与鉴定、药敏试验、耐药基因检测、毒力因子基因检测、多位点序列的克隆分型。结果药敏试验结果显示,XJ-K1与XJ-K2菌株呈广泛耐药性,对哌拉西林、氨苄西林、头孢曲松、头孢呋辛、头孢唑林、阿米卡星、卡那霉素、奈替米星的耐药率为100.00%;对头孢他啶、头孢替坦、头孢西丁、美罗培南、亚胺培南、庆大霉素、环丙沙星、左氧氟沙星、多西环素、米诺环素、四环素、替加环素、磷霉素、呋喃妥因、利奈唑胺的耐药率为27.08%~97.26%,对多黏菌素B的耐药率仅为10.42%和9.59%。XJ-K1对耐药基因blaTEM-1、blaKPC、blaSHV、rmtB、qnrS、tetA的检出率为6.25%~72.92%,XJ-K2的检出率为26.03%~67.12%。XJ-K1对高毒力基因iucA、iucB、iucC、iucD、iutA、rmpA、rmpA2、iroN的检出率为8.33%~83.33%,XJ-K2的检出率为27.40%~82.19%。克隆分型:XJ-K1菌株ST1型占12.50%,ST11型占87.50%。XJ-K2菌株ST1型占9.59%,ST11型占90.41%。结论重症科分离的广泛耐药高毒力肺炎克雷伯菌XJ-K1与XJ-K2携带的耐药基因主要为blaTEM-1、blaKPC、blaSHV、rmtB、qnrS、tetA,毒力基因主要为iucA、iucB、iucC、iucD、iutA、rmpA、rmpA2、iroN,克隆分型主要为ST11型。OBJECTIVE To investigate the characteristics of drug resistance,virulence factors and clonal typing of extensively drug-resistant and highly toxic Klebsiella pneumoniae XJ-K1 and XJ-K2 isolated from intensive care unit.METHODS A total of 121 strains of extensively drug-resistant and highly toxic K.pneumoniae XJ-K1 and XJ-K2 were collected in the intensive care unit of Taihe Hospital Affiliated to Hubei Medical College from Jan 2019 to Dec 2021.XJ-K1 strain was isolated from urine samples(n=48),and XJ-K2 strain was from blood samples(n=73).The strains were cultured and identified,and drug susceptibility test,drug resistance gene detection,virulence factor gene detection,and clonal typing of multi-locus sequences were carried out.RESULTS Drug sensitivity test showed that XJ-K1 and XJ-K2 strains were widely drug-resistant,and the resistance rate to piperacillin,ampicillin,ceftriaxone,cefuroxime,cefazolin,amikacin,kanamycin and netilmicin was 100.00%.The resistance rates to ceftazidime,cefotetAn,cefoxitin,meropenem,imipenem,gentamicin,ciprofloxacin,levofloxacin,doxycycline,minocycline,tetracycline,tegacyclin,fosfomycin,nitrofurantoin and linezolid were 27.08%-97.26%,and the resistance rates to polymyxin B were only 10.42%and 9.59%,respectively.The detection rates of drug resistance genes bla_(TEM-1),bla_(KPC),bla_(SHV),rmtB,qnrS,tetA were 6.25%-72.92%for XJ-K1 and 26.03%-67.12%for XJ-K2.The detection rates of high virulence genes including iucA,iucB,iucC,iucD,iutA,rmpA,rmpA2 and iroN were 8.33%-83.33%for XJ-K1 and 27.40%-82.19%for XJ-K2.ST1 clonal typing in XJ-K1 strain accounted for 12.50%,and ST11 accounted for 87.50%.ST1 type in XJ-K2 strain accounted for 9.59%,and ST11 accounted for 90.41%.CONCLUSION The resistant genes carried by XJ-K1 and XJ-K2 were bla_(TEM-1),bla_(KPC),bla_(SHV),rmtB,qnrS,tetA,and the virulence genes were iucA,iucB,iucC,iucD,iutA,rmpA,rmpA2 and iroN.The clonal typing was mainly ST11.

关 键 词：肺炎克雷伯菌 广泛耐药 耐药基因 毒力因子 克隆分型 重症医学科 

分 类 号：R378.996[医药卫生—病原生物学]