住院患者与环境分离的CRKP同源性及其传播特征  

Homology of carbapenem-resistant Klebsiella pneumoniae isolated from inpatients and environment and its transmission characteristics

作　　者：黄菊 肖瑜 陆丹倩 王巧媚 彭拓华 林淑健 杨坚娥 李亮 HUANG Ju;XIAO Yu;LU Dan-qian;WANG Qiao-mei;PENG Tuo-hua;LIN Shu-jian;YANG Jian-e;LI Liang(Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine,Zhongshan,Guangdong 528401,China;不详)

机构地区：[1]广州中医药大学附属中山中医院医院感染管理科,广东中山528401 [2]广州中医药大学附属中山中医院医院检验科,广东中山528401 [3]广东省生物制品与药物研究所耐药监测室,广东广州510000

出　　处：《中华医院感染学杂志》2024年第4期607-612,共6页Chinese Journal of Nosocomiology

基　　金：广东省中医药局基金资助项目(20211053);中山市科学技术局科研基金资助项目(2020B1089)。

摘　　要：目的按探讨碳青霉烯耐药肺炎克雷伯菌(CRKP)感染患者及同病房患者与环境分离CRKP的同源性、耐药机制及传播特征。方法收集中山市中医院2017-2022年全院CRKP菌株,从2020年1月开始对CRKP感染患者的同病房患者筛查直肠拭子,对CRKP感染患者周围环境采样,筛查CRKP;使用胶体金法检测碳青霉烯酶基因,运用脉冲场凝胶电泳技术(PFGE)进行同源性分析。结果共收集CRKP菌株39株,其中患者菌株36株,筛查同病房患者直肠拭子61例,检出CRKP菌株2株,采集环境标本680份,1名CRKP患者的卫生间水槽下水口检出CRKP;39株CRKP中产KPC酶9株(23.08%),产NDM酶21株(53.85%),9株未检出常见的5种碳青霉烯酶;PFGE分析发现39株CRKP分为18个克隆型,6年内医院内发生过3次CRKP克隆传播。结论加强CRKP感染患者房间水槽的消毒,可阻止CRKP通过水槽引起传播;医院内各时段流行的CRKP基因型可能不同,明确其类型对指导治疗决策有重要意义。医院内流行是CRKP检出率上升的原因,同源性分析结果可为确定主动筛查的目标患者提供依据。OBJECTIVE To explore the homology,drug resistance mechanism and transmission characteristics of patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)infection,CRKP infection patients in the same ward,and CRKP isolated from the environment.METHODS CRKP strains were collected from 2017 to 2022 in Zhongshan Hospital of Traditional Chinese Medicine,and rectal swabs were screened from Jan.2020 for patients in the same ward with CRKP,and the surrounding environments of CRKP infection patients were sampled to screen for CRKP.The carbapenem enzyme gene of all strains was detected by gold immunochromatography assay,and the homology was analyzed by pulsed-field gel electrophoresis(PFGE).RESULTS A total of 39 CRKP strains were collected,including 36 strains from patients.61 rectal swabs from patients in the same ward were screened,and 2 CRKP strains were detected,680 environmental samples were collected,and CRKP was detected in the bathroom sink outlet of a patient with CRKP.Of the 39 CRKP strains,9 strains produced KPC enzyme,21 strains(53.85%)produced NDM enzyme,and five common carbapenemase were not detected in 9 CRKPs.PFGE analysis revealed that 39 CRKP strains were divided into 18 clone types,and there were 3 cases of CRKP clone transmissions in the hospitals within a 6-year period.CONCLUSION Strengthening the disinfection of the sink in CRKP infection patients'rooms might prevent the spread of CRKP through the sinks.The genotypes of CRKP prevalent in hospitals might be different at different times of the day,and clarification of their types was of great significance for guiding treatment decisions.Intra-hospital prevalence was responsible for the increase in CRKP detection rates,and the results of homology analysis might provide a basis for identifying the target patients for activescreening.

关 键 词：住院患者 环境 碳青霉烯耐药肺炎克雷伯菌 胶体金免疫层析技术 脉冲场凝胶电泳技术 同源性分析 水槽 

分 类 号：R378[医药卫生—病原生物学]