耐碳青霉烯类肺炎克雷伯菌血流感染的临床特征及耐药分子分析  

Clinical characteristics and drug-resistant molecule analysis of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

作　　者：张泽智 徐佳[1] Zhang Zezhi;Xu Jia(Shenyang Medical College,Shenyang 110034)

机构地区：[1]沈阳医学院,辽宁沈阳110034 [2]承德医学院附属医院检验科,河北承德067000

出　　处：《中国现代医药杂志》2023年第11期18-22,共5页Modern Medicine Journal of China

基　　金：辽宁省博士科研启动基金计划项目(编号:2020-BS-268)。

摘　　要：目的分析耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染的临床特征及耐药分子。方法选择2019~2022年承德医学院附属医院两院区住院患者血培养阳性且鉴定为肺炎克雷伯菌的标本2054份,均行药敏试验,排除重复菌后将238例CRKP感染患者设为CRKP组;以性别、年龄1:1配对,选择238例碳青霉烯类敏感肺炎克雷伯菌(CSKP)感染患者作为对照组,比较两组临床特征和耐药性。对238株CRKP菌株采用聚合酶链反应(PCR)检测碳青霉烯酶基因,根据巴斯德研究所多位点序列分型(MLST)网站分型,对耐药分子进行分析。结果CRKP组入住ICU患者的比例高于对照组,侵入性操作中留置尿管、留置引流管、手术、气管插管机械通气、中心静脉置管率高于对照组,使用抗生素类型中碳青霉烯类、β-内酰胺和β-内酰胺酶抑制剂、糖肽类、替加环素使用率高于对照组,两种及以上抗生素联用率高于对照组,第三、四代头孢菌素使用率高于对照组,伴随心脑血管疾病、恶性肿瘤、感染性休克、肾脏疾病、烧伤患者的比例高于对照组,死亡率高于对照组,差异均有统计学意义(P<0.05)。CRKP组238株菌株均为多重耐药菌,对庆大霉素、头孢西丁、美罗培南、头孢他啶、头孢哌酮/舒巴坦、亚胺培南、氨曲南的耐药率均为100.00%,对阿米卡星、左氧氟沙星的耐药率最低,但也达81.09%、83.61%,对哌拉西林/他唑巴坦、头孢曲松的耐药率为89.92%、98.32%;耐药率均高于对照组,差异均有统计学意义(P<0.05)。227株Hodge试验阳性菌株中162株携带blaKPC-2基因,占71.37%;35株携带blaNDM-1基因,占15.42%;11株携带blaNDM-2基因,占4.85%,10株携带blaOXA-48基因,占4.41%;9株同时携带blaKPC-2基因与blaNDM-1基因,占3.96%。未检出携带blaIMP、blaVIM基因的菌株。按碳青霉烯酶基因比例选择79株CRKP菌株进行MLST分型,共检测出13种ST分型,其中ST11分型最多,占62.03%,其次为ST15(7.59%)、STObjective To analyze the clinical characteristics and drug-resistant molecule of carbapenemresistant Klebsiella pneumoniae(CRKP)bloodstream infection.Methods 2054 blood culture positive samples identified as Klebsiella pneumoniae were selected from inpatients in the Affiliated Hospital of Chengde Medical College from 2019 to 2022.Drug susceptibility tests were performed on all of them.After the exclusion of repeated bacteria,238 patients with CRKP infection were assigned as CRKP group.A total of 238 carbapenem sensitive Klebsiella pneumoniae(CSKP)patients were selected as the control group by sex and age 1:1 matching.The clinical characteristics and drug-resistance of the two groups were compared.The carbapenemase gene of 238 CRKP strains was detected by polymerase chain reaction(PCR),and the drug-resistant molecule were analyzed according to the multisite sequence typing(MLST)of Institut Pasteur.Results The proportion of patients admitted to ICU in the CRKP group was higher than that in the control group,the rates of indurating urinary tube,indurating drainage tube,surgery,tracheal intubation mechanical ventilation and central venous catheterization in invasive procedures were higher than that in the control group,and the rates of carbapenem,β-lactam andβ-lactam inhibitors,glycopeptides and tigecycline used in antibiotics were higher than that in the control group.The combination rate of the two or more antibiotics was higher than that of the control group,the rates of using the third and fourth generation cephalosporins were higher than those in the control group,the proportion of patients with cardiovascular and cerebrovascular disease,malignant tumor,septic shock,kidney disease and burn were higher than that of the control group,and the mortality was higher,with statistical significance(all P<0.05).All 238 strains in CRKP group were multi-drug resistant bacteria,and the resistance rates to gentamicin,cefoxitin,meropenem,ceftazidime,cefoperazone/sulbactam,imipenem and amtraxam were 100.00%,while the resistan

关 键 词：耐碳青霉烯类肺炎克雷伯菌 血流感染 临床特征 耐药分子 

分 类 号：R446.5[医药卫生—诊断学]