携带不同酶型基因耐碳青霉烯肺炎克雷伯菌对常见抗耐药菌药物的敏感性观察  

Sensitivity of drug-resistant Klebsiella pneumoniae carrying different carbapenemasetype genes to the commonly used anti-CRKP drugs

作　　者：裘雪丹 李情操 吴巧萍 施盈娜 QIU Xue-dan;LI Qing-cao;WU Qiao-ping;SHI Ying-na(Laboratory of Ningbo Medical Center Lihuili Hospital,Ningbo Zhejiang 315040,China)

机构地区：[1]宁波大学附属李惠利医院,浙江宁波315040

出　　处：《中国消毒学杂志》2024年第2期103-106,109,共5页Chinese Journal of Disinfection

基　　金：浙江省医药卫生科技项目(2021KY1031、2024KY288);宁波市医学科技项目(2022Y03)。

摘　　要：目的了解宁波地区耐碳青霉烯肺炎克雷伯菌(CRKP)菌株携带碳青霉烯酶型基因分布,以及携带不同碳青霉烯酶型基因的CRKP对常见抗耐药菌药物的敏感性。方法选择2019年1月—2021年12月宁波地区多家中心市医院临床非重复分离的CRKP共150株,采用PCR法检测碳青霉烯酶基因携带情况;采用肉汤稀释法检测常用抗CRKP药物替加环素、多黏菌素B、头孢他啶/阿维巴坦对分离CRKP的敏感性;采用K-B法检测CRKP对8种报道中使用的联合药物的敏感性。结果宁波地区CRKP菌株主要携带KPC-2型耐药基因,其次是NDM-1型耐药基因,对替加环素、多黏菌素B敏感率均较高;头孢他啶/阿维巴坦对携带A类酶基因的CRKP的作用力较强,对携带B类、D类酶基因的CRKP作用弱;磷霉素、阿米卡星和氯霉素的抑菌圈直径较大,可以作为治疗CRKP感染的联合药物,氨曲南和阿米卡星可用于治疗携带B类酶基因的CRKP感染。结论部分抗菌药物对携带不同酶型基因菌株敏感性不同。Objective To investigate the distribution of carbapenemase-type genes in CRKP strains in Ningbo,and to investigate the sensitivity of CRKPs carrying different carbapenemase-type genes to the commonly used anti-CRKP drugs.Methods A total of 150 CRKP strains isolated from clinical non-duplication in hospitals in Ningbo from January 2019 to December 2021 were selected,and the carbapenemase genes were detected by PCR.The broth dilution method was used to detect the sensitivity of the commonly used anti-CRKP drugs tigecycline,polymyxin B and ceftazidime/avibactam to the isolation of CRKP.The K-B method was used to detect the sensitivity of CRKP to 8 kinds of combination drugs used in reports.Results The CRKP strains in this region mainly carried KPC-2 resistance genes,followed by NDM-1 resistance genes,and had high susceptibility rates to tigecycline and polymyxin B.Ceftazidime/avibactam had effect on CRKP carrying class A enzyme genes,but had weak effect on CRKP carrying class B and D enzyme genes.Fosfomycin,amikacin,and chloramphenicol had a large inhibition zone diameter and could be used as combination drugs for the treatment of CRKP infection.Aztreonam and amikacin could be used to treat CRKP infection carrying class B enzyme genes.Conclusion Antimicrobial drugs have different effect on strains carrying different enzyme types and genes.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 碳青霉烯酶型 替加环素 头孢他啶/阿维巴坦 多黏菌素B 

分 类 号：R184[医药卫生—流行病学]