2020—2021年湖南省某医院分离自重症监护室的耐碳青霉烯类肺炎克雷伯菌的分子流行病学特征分析  

Molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae in intensive care unit of a hospital in Hunan Province from 2020 to 2021

作　　者：周杰英[1] 丁丽 彭小友 袁红霞[1] 史文元[1] 胡付品 ZHOU Jieying;DING Li;PENG Xiaoyou;YUAN Hongxia;SHI Wenyuan;HU Fupin(Department of Laboratory Medicine,the First People’s Hospital of Hunan Chenzhou,Chenzhou Hunan 423000,China)

机构地区：[1]湖南省郴州市第一人民医院检验科,湖南郴州423000 [2]复旦大学附属华山医院抗生素研究所,国家卫健委抗生素临床药理重点实验室.

出　　处：《中国感染与化疗杂志》2024年第5期564-569,共6页Chinese Journal of Infection and Chemotherapy

基　　金：湖南省自然科学基金区域联合基金项目(2023JJ50387)。

摘　　要：目的研究2020—2021年湖南省某三甲医院重症监护室(ICU)分离的耐碳青霉烯类肺炎克雷伯菌(CRKP)菌株的科室分布、药敏特征、碳青霉烯酶耐药基因、毒力基因、荚膜血清型以及ST分型,为CRKP感染的临床治疗提供科学依据。方法收集2020年1月至2021年12月郴州市第一人民医院8个ICU分离的75株CRKP菌株,应用MALDI-TOF质谱仪和VITEK-2 Compact药敏分析仪分别进行菌种鉴定和药敏试验,采用改良碳青霉烯灭活试验检测碳青霉烯酶表型,用wzi基因测序法进行荚膜血清型测定,运用Sanger测序对碳青霉烯类耐药基因和毒力基因进行分析,采用多位点序列分型(MLST)检测ST分型。结果75株CRKP菌株主要分布在老年内科ICU(28.0%)和脑外科ICU(20.0%);CRKP对替加环素和头孢他啶-阿维巴坦的耐药率分别为6.7%(5/75)和16.0%(12/75),对碳青霉烯类、头孢菌素、β内酰胺类-β内酰胺酶抑制剂复方制剂和左氧氟沙星耐药率高(>96.0%);61株(81.3%)携带bla_(KPC-2)耐药基因,11株(14.7%)携带bla_(NDM-1)基因,1株(1.3%)携带bla_(NDM-5)基因,2株(2.7%)携带bla_(OXA-48)基因;ST分型前三位的主要为ST11型(54.7%,41/75)、ST1883(13.3%,10/75)、ST307(6.7%,5/75),所有ST11型和ST1883型CRKP均携带bla_(KPC-2);主要流行的荚膜血清型为KL64(38.7%,29/75)和KL47(25.3%,19/75);主要携带的毒力基因是rmpA2(48.0%,36/75)、iroN(38.7%,23/75)和iucA(37.3%,15/75)。结论该院ICU的CRKP菌株细菌耐药程度高,以ST11-KL64型和ST11-KL47型为主,大多数菌株携带bla_(KPC-2)基因和毒力基因。应该加强监测CRKP分子流行病学分析和酶型检测,从而指导临床CRKP感染的个体化和精准化治疗。Objective To investigate the clinical distribution,antimicrobial resistance,carbapenemase resistance genes,virulence genes,capsular serotypes and ST subtypes of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains in intensive care unit of a tertiary hospital in Hunan Province for better management of CRKP infections.Methods CRKP strains were isolated from 8 intensive care units of the First People’s Hospital of Chenzhou City from January 2020 to December 2021.The isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and tested by VITEK Compact 2 for antimicrobial susceptibility.Carbapenemase phenotype was detected by modified carbapenem inactivation method(mCIM).The capsular serotypes were determined by wzi sequencing.Carbapenem resistance genes and virulence genes were identified by PCR and Sanger sequencing.The strains were also analyzed by multilocus sequence typing(MLST)in terms of ST subtypes.Results The 75 CRKP strains were mainly isolated from geriatric ICU(28.0%)and neurosurgery ICU(20.0%).Overall,6.7%(5/75)and 16.0%(12/75)of the CRKP strains were resistant to tigecycline and ceftazidime-avibactam,respectively.The CRKP strains(>96.0%resistant)were highly resistant to carbapenems,cephalosporins,β-lactam/β-lactamase inhibitor combinations,and levofloxacin.PCR and sequencing analysis found bla_(KPC-2) gene in 61 strains(81.3%),bla_(NDM-1) gene in 11 strains(14.7%),bla_(NDM-5) gene in 1 strain(1.3%),and bla_(OXA-48) gene in 2 strains(2.7%).MLST revealed that ST11(54.7%,41/75),ST1883(13.3%,10/75),and ST307(6.7%,5/75)were the top three ST subtypes.All ST11 and ST1883 CRKP strains harbored bla_(KPC-2).KL64(38.7%,29/75)and KL47(25.3%,19/75)were the most prevalent capsular serotypes among the 75 CRKP strains.The most common virulence genes among these CRKP strains were rmpA2(48.0%,36/75),iroN(38.7%,23/75)and iucA(37.3%,15/75).Conclusions The CRKP strains isolated from the intensive care units were mainly ST11-KL64 and ST11-KL47 types.Most of the strains ha

关 键 词：肺炎克雷伯菌 碳青霉烯酶耐药基因 毒力基因 荚膜血清型 多位点序列分析 

分 类 号：R378.996[医药卫生—病原生物学]