碳青霉烯耐药肺炎克雷伯菌耐药机制及分子流行病学研究  

Resistance genes and molecular epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae

作　　者：徐添天 谢强[1] 谢瑞玉 汤德刚[2] XU Tiantian;XIE Qiang;XIE Ruiyu;TANG Degang(Department of Laboratory Medicine,the Afiliated Chuzhou Hospital of Anhui Medical University,the First People's Hospital of Chuzhou,Chuzhou,Anhui 239001,China;Department of Neurosurgery,the Afiliated Chuzhou Hospital of Anhui Medical University,the First People's Hospital of Chuzhou,Chuzhou,Anhui 239001,China)

机构地区：[1]安徽医科大学附属滁州医院滁州市第一人民医院检验科,安徽滁州239001 [2]安徽医科大学附属滁州医院滁州市第一人民医院神经外科,安徽滁州239001

出　　处：《热带医学杂志》2023年第4期484-487,共4页Journal of Tropical Medicine

基　　金：安徽省卫生健康委科研项目(AHWJ2021b005);滁州市科技计划项目(2021ZD006)。

摘　　要：目的分析耐碳青霉烯肺炎克雷伯菌(CRKP)的耐药情况及耐药基因,为临床治疗提供依据。方法收集并鉴定临床分离非重复CRKP 27株,采用VITEK-2 compact全自动微生物鉴定药敏分析仪鉴定和药敏试验,碳青霉烯酶抑制剂增强试验检测A类丝氨酸碳青霉烯酶和B类金属β内酰胺酶,聚合酶链反应(PCR)法和基因测序技术检测常见的耐药基因。使用肠杆菌科基因间重复一致序列PCR(ERIC-PCR)对菌株进行同源性分析。结果27株肺炎克雷伯菌对碳青霉烯类、头孢菌素类、喹诺酮类等抗生素的耐药率均>96%。碳青霉烯酶抑制剂增强试验显示,26株A类丝氨酸碳青霉烯酶阳性,1株B类金属β内酰胺酶阳性。PCR和基因测序结果显示,26株CRKP携带KPC-2基因,1株携带NDM-1基因。ERIC-PCR将27株CRKP分为8型,以Ⅰ型和Ⅱ型为主。结论分离的CRKP对临床常用抗生素表现出高水平耐药,其耐药机制主要是该类细菌产KPC-2型碳青霉烯酶。Objective To investigate the epidemiological characteristics and resistance mechanism of carbapenem-resistant Klebsiella pneumonia(CRKP),and provide the basis for the clinical treatment.Methods A total of 27 clinical strains of CRKP were collected and identified.The identificition and antibiotic susceptibility test were carried out with the automatic VITEK-2 compact system.Carbapenemase inhibitor enhancement test was usded to detect the carbapenem class A enzymes and the carbapenem class B enzymes.The carbapenemase resistance genes were detected by polymerase chain reaction(PCR)and DNA sequence analysis.The homology of resistant strains was analyzed by enterobacterial repetitive intergenic consensus-polymerase chain reaction(ERIC-PCR).Results The date showed that the resistant rate of CRKP to carbapenems,cephalosporins and quinolones were more than 96%.Carbapenemase inhibitor enhancement test showed that26 strains harboured the carbapenem class A enzymes and one had the carbapenem class B enzymes.PCR and DNA sequence analysis result showed that 26 strains were KPC-2 type and one was NDM-1.ERIC-PCR result showed that 27strains of CRKP were divided into 8 types,and the main type were typeⅠandⅡ.Conclusion The isolated CRKP showed a high level of resistance to clinical antibacterial drugs;its resistance mechanism was mainly the KPC-2 carbapenemase produced by these bacteria.

关 键 词：肺炎克雷伯菌 碳青霉烯酶 耐药基因 

分 类 号：R446.5[医药卫生—诊断学]