2018-2020年江西省高毒力耐碳青霉烯类肺炎克雷伯菌分子流行病学特征  

Molecular epidemiological characteristics of highly virulent carbapenem-resistant Klebsiella pneumoniae in Jiangxi Province from 2018 to 2020

作　　者：刘岩 曾凌 卢才菊[3] 向天新[2] 周芸[2] 刘露露 汤金华 LIU Yan;ZENG Ling;LU Cai-Ju;XIANG Tian-Xin;ZHOU Yun;LIU Lu-lu;TANG Jin-Hua(Nanchang University,Nanchang,Jiangxi 330036,China;不详)

机构地区：[1]南昌大学护理学院,江西南昌330036 [2]南昌大学第一附属医院感染控制处,江西南昌330036 [3]南昌大学第一附属医院呼吸科,江西南昌330036

出　　处：《中华医院感染学杂志》2023年第11期1601-1606,共6页Chinese Journal of Nosocomiology

基　　金：江西省卫生健康委科技计划基金资助项目(202210214)。

摘　　要：目的分析江西地区高毒力耐碳青霉烯类肺炎克雷伯菌(CR-hvKP)的流行病学和分子生物学特征。方法收集2018-2020年江西省11个地级市医院分离的非重复耐碳青霉烯类肺炎克雷伯菌(CRKP)菌株,对其进行药物敏感试验、耐药基因、荚膜血清型、毒力基因及多位点序列分型(MLST)分析。结果共检出CRKP 749株,其中CR-hvKP 126株(16.82%);126株CR-hvKP主要分离于痰液(n=60,47.62%)和血液(n=41,32.54%);主要来自于重症监护室(ICU)(n=81,64.29%);药敏结果显示除阿米卡星和替加环素外,菌株对其他抗菌药物耐药率均较高;耐药基因检测结果显示,肺炎克雷伯菌碳青霉烯酶(bla_(KPC))基因携带率最高(n=102,80.95%);荚膜血清型和毒力基因检测显示,K64型CR-hvKP检出最多(n=111,88.10%);ST分型提示,所检测引起脓肿的CR-hvKP均为产KPC酶的ST11菌株。结论江西省CR-hvKP检出率较高,对绝大多数抗菌药物耐药,提示临床需合理使用抗菌药物。耐药基因和毒性基因携带率均较高,应进一步加强院感防控,警惕菌株变异,防止医院暴发CR-hvKP感染。OBJECTIVE To analyze the epidemiological and molecular biological characteristics of highly viruluent carbapenem-resistant Klebsiella pneumoniae(CR-hvKP)in Jiangxi Province.METHODS Non-replicated CRKP strains isolated from 11 prefecture-level hospitals in Jiangxi Province from 2018-2020 were collected,and antimicrobial susceptibility analysis,resistance genes,podoconjugate serotypes,virulence genes and multi-locus sequence typing(MLST)were analyzed.RESULTS A total of 749 carbapenem-resistant Klebsiella pneumoniae(CRKP)strains were detected,including 126 CR-hvKP strains(16.82%);the 126 CR-hvKP strains were mainly isolated from sputum(n=60,47.62%)and blood(n=41,32.54%),and mainly from the intensive care unit(ICU)(n=81,64.29%).The antimicrobial susceptibility test showed that except for amikacin and tigecycline,126 strains of CR-hvKP were highly resistant to other antibiotics.The results of resistance gene testing showed that Klebsiella pneumoniae carbapenemase(KPC)gene carriage was the highest(n=102,80.95%).Podoconjugate serum and virulence gene assays showed that K64 type CR-hvKP was detected most frequently(n=111,88.10%).MLST analysis showed that all CR-hvKP tested for abscess-causing strains were KPCase-producing ST11 strains.CONCLUSION The detection rate of CR-hvKP in Jiangxi was high,and it was resistant to most antibacterial drugs,suggesting the need for rational clinical use of antibiotics.The high carriage rates of both drug-resistant genes and virulence genes suggested that hospital outbreaks of CR-hvKP infection should be prevented by further strengthening the prevention and control of hospital-acquired infections and being alert to strain mutations.

关 键 词：江西省 耐碳青霉烯类肺炎克雷伯菌 高毒力 耐药性 分子流行病学 临床分离株 

分 类 号：R378[医药卫生—病原生物学]