ICU耐碳青霉烯类肺炎克雷伯菌感染菌与肠道定植菌耐药基因及同源性关系  

Drug resistant genes in carbapenem-resistant Klebsiella pneumoniae causing infection and intestinal colonized strains from ICU patients and homology between them

作　　者：夏粉芳 张培林 何俊凝 郭杨柳 肖敏[4] 谭莎莎 刘永芳 林家福[1] XIA Fen-fang;ZHANG Pei-lin;HE Jun-ning;GUO Yang-liu;XIAO Min;TAN Sha-sha;LIU Yong-fang;LIN Jia-fu(The Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China;不详)

机构地区：[1]川北医学院附属医院感染科,四川南充637000 [2]大竹县人民医院感染科,四川大竹635100 [3]川北医学院附属医院检验科,四川南充637000 [4]川北医学院附属医院重症监护室,四川南充637000 [5]川北医学院附属医院神经外科,四川南充637000 [6]成都市第三人民医院感染科,四川成都610031

出　　处：《中华医院感染学杂志》2023年第21期3213-3218,共6页Chinese Journal of Nosocomiology

基　　金：四川省预防医学会基金资助项目(SCGK202102)。

摘　　要：目的探索重症监护室(ICU)患者耐碳青霉烯类肺炎克雷伯菌(CRKP)感染菌和肠道定植菌耐药基因及同源性关系.方法收集2020年6月1日-2022年11月30日川北医学院附属医院神经外科ICU、中心ICU及急诊ICU患者中从CRKP感染到肠道定植、CRKP肠道定植到感染各20例患者分离的CRKP菌株,对其CRKP菌株进行耐药基因检测,采用肠杆菌科基因间重复序列聚合酶链反应(ERIC-PCR)技术进行同源性分析.结果40例患者共收集CRKP菌株98株.同一患者CRKP定植菌和感染菌株均携带KPC基因.遗传聚类分析显示,98株CRKP可分为A~G型7种不同菌型.同一菌型在同一时间段内不同ICU检出,同一时段不同患者菌株间同源性较高,同一ICU同时段有同一菌型聚集现象.两组各有18例患者定植菌和感染菌间相似系数>0.85,其亲缘关系较近;虽两组各有2例患者定植菌与感染菌之间亲缘关系较远,但其定植菌或感染菌与同科室或不同科室其他患者定植菌或感染菌之间具有较高同源性.结论同一患者CRKP肠道定植菌和感染菌株之间所携带的耐药基因一致,均为KPC型.两组患者自身肠道定植菌和感染菌株之间同源性均较高.存在同一时段的一个CRKP克隆菌株在不同患者间传播流行现象,也存在不同科室间的流行现象.OBJECTIVE To explore the drug resistance genes in carbapenem-resistant Klebsiella pneumoniae(CRKP)causing infection and intestinal colonized bacteria from the patients of intensive care unit(ICU)and analyze the homology between them.METHODS The CRKP strains were collected from 20 patients of each who had CRKP infection to intestinal colonization and intestinal colonization of CRKP to infection and were treated in ICU of neurosurgery department,central ICU and emergency ICU of the Affiliated Hospital of North Sichuan Medical College from Jun l,2020 to Nov 30,2022.The drug resistance genes in the CRKP strains were detected,and the homology was analyzed by using enterobacterial repetitive intergenic consensus-polymerase chain reaction(ERICPCR).RESULTS A total of 98 strains of CRKP were collected from the 40 patients.Both the colonized CRKP strain and the infection strain from the same patient carried with KPC gene.Genetic clustering analysis showed that 98 strains of CRKP could be divided into 7 types from A to G.The same type was detected in different ICUs during the same period of time,the homology among the strains that were detected in different patients during the same period of time was relatively high.There was aggregation of the same type of strain in the same ICU during the same period of time.There were 18 patients of each group who had the similarity coefficient between the colonized strain and the infection more than O.85,and the kinship was relatively close.Although two patients in each of the two groups had a distant relationship between the colonized strain and the infection strain,the colonized strain or the infection strain had high homology with the colonized strain or infection strain from other patients in the same department or different departments.CONCLUSION The intestinal colonized CRKP strain and the infection strain from the same patient carry with the same drug resistance genes,all of which were KPC type.The homology between the self-colonized intestinal strain and the infection strain is

关 键 词：重症监护室 耐碳青霉烯类肺炎克雷伯菌 肠道定植 感染 耐药基因 同源性 

分 类 号：R378.996[医药卫生—病原生物学]