耐碳青霉烯肺炎克雷伯菌耐药特征及联合治疗策略  

Resistance Characteristics of Carbapenem-Resistant Klebsiella Pneumoniae and Combination Therapy Strategies

作　　者：张峻梅[1] 杨莉莉[1] 刘敏[1] 冯小艳[1] 彭溪[1] 李霜 Zhang Junmei;Yang Lili;Liu Min;Feng Xiaoyan;Peng Xi;Li Shuang(Department of Laboratory Medicine,The Third People's Hospital of Chengdu,Chengdu 610031,China)

机构地区：[1]成都市第三人民医院临床医学检验部,成都610031

出　　处：《成都医学院学报》2024年第3期502-505,529,共5页Journal of Chengdu Medical College

摘　　要：目的 分析耐碳青霉烯肺炎克雷伯菌(CRKP)的基因分型和耐药性,并评估头孢他啶/阿维巴坦(CZA)与其他抗菌药物联合使用对CRKP治疗效果的影响,为临床提供更有效的治疗策略。方法 分析2023年10-12月成都市第三人民医院住院患者标本中分离的CRKP菌株。采用Atofms100全自动微生物质谱检测仪和MicroScan-96细菌鉴定及药敏分析仪对菌株进行鉴定和药敏分析,用胶体金免疫层析技术对菌株进行耐碳青霉烯酶基因分型。采用纸片扩散法检测CZA与氨曲南(ATM)、美罗培南(MEM)联合应用的药敏反应。结果 共分离出CRKP 210株,其中产丝氨酸碳青霉烯酶126株(占比60.0%),产金属β-内酰胺酶81株(占比38.6%)。CRKP对多数β-内酰胺类和碳青霉烯类抗生素表现出高耐药率,而对多粘菌素B、替加环素和CZA表现出较高敏感性。携带不同耐药基因类型的CRKP在药物敏感性上有所分化。CZA与ATM、MEM的联合药敏试验显示,对于产金属β-内酰胺酶和产丝氨酸碳青霉烯酶CRKP菌株,CZA与ATM展现出良好的协同作用,协同率分别为100.0%(81/81)和99.2%(125/126);对于产丝氨酸碳青霉烯酶CRKP,CZA与MEM也显示出协同作用,协同率为99.2%(125/126)。结论 CRKP分离率高,耐药性强。不同基因亚型的CRKP抗菌药物敏感性有所差异。CZA与ATM、MEM的联合使用为治疗不同基因分型CRKP感染提供了有效策略。建议在临床治疗中,根据CRKP的产酶类型选择合适的联合用药方案。Objective To analyze the genotyping and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP),and evaluate the treatment effectiveness of the combination of Ceftazidime/Avibactam(CZA)with other antibiotics against CRKP,so as to provide more effective treatment strategies.Methods CRKP strains isolated from the inpatients in the Third People's Hospital of Chengdu from October to December 2023 were analyzed.Atofms100 automatic microbial mass spectrometer and MicroScan-96 bacterial identification and susceptibility analyzer were used to identify the strains and analyze their drug susceptibility.Colloidal gold immunochromatography technology was employed to genotype the carbapenemase-resistant genes of the strains.The combined drug susceptibility tests of CZA with aztreonam(ATM)and meropenem(MEM)were performed using the paper disk diffusion.Results A total of 210 strains of CRKP were isolated,among which 126 strains(60.0%)produced serine carbapenemase,and 81 strains(38.6%)produced metallo-β-lactamase.CRKP showed high resistance rates to mostβ-lactams and carbapenems but exhibited relatively high sensitivity to polymyxin B,tigecycline,and CZA.CRKP with different resistance genotypes differed in drug susceptibility.The susceptibility test of CZA combined with ATM demonstrated good synergistic effects in both metallo-β-lactamase producing and serine carbapenemase-producing CRKP strains,with synergy rates of 100%(81/81)and 99.2%(125/126),respectively.And the susceptibility test of CZA combined with MEM also showed synergistic effects in serine carbapenemase-producing CRKP strains,with a synergy rate of 99.2%(125/126).Conclusion CRKP has a high isolation rate and strong drug resistance.The sensitivity of CRKP to antimicrobial drugs varies with different genetic subtypes.The combined use of CZA with ATM or MEM provides effective strategies for treating infections caused by different genetic subtypes of CRKP.It is recommended that in clinical treatment,appropriate combination therapy schemes should be select

关 键 词：耐碳青霉烯肺炎克雷伯菌 流行病学 耐药 联合药敏试验 

分 类 号：R378.99[医药卫生—病原生物学]