多重耐药肺炎克雷伯菌整合子、ISCR1分布与耐药性研究及ERIC-PCR分型特点  

Integrons and ISCR1 distribution and ERIC-PCR analysis of multidrug-resistant Klebsiella pneumoniae

作　　者：张凤宜 姜冰洁 芮勇宇[1] ZHANG Fengyi;JIANG Bingjie;RUI Yongyu(Department of Clinical Laboratory,Nanfang Hospital of Southern Medical University,Guangzhou,Guangdong 510515,China;Department of Clinical Laboratory,the Tenth Affiliated Hospital of Southern Medical University/Dongguan People's Hospital,Dongguan,Guangdong 523000,China)

机构地区：[1]南方医科大学南方医院检验科,广东广州510515 [2]南方医科大学第十附属医院/东莞市人民医院检验科,广东东莞523000

出　　处：《检验医学与临床》2025年第3期370-376,共7页Laboratory Medicine and Clinic

基　　金：广东省基础与应用基础研究基金项目(2023A1515220106)。

摘　　要：目的研究多重耐药肺炎克雷伯菌(MDR-KP)中整合子和插入序列共同区(ISCR1)的分布特征和携带耐药基因情况,以及采用肠杆菌基因间重复共有序列聚合酶链反应(ERIC-PCR)分析MDR-KP的基因分型特点,为加强肺炎克雷伯菌耐药监测及临床用药提供可靠的理论依据。方法收集南方医科大学南方医院临床分离的非重复的MDR-KP 68株作为实验菌株,提取细菌DNA,利用PCR检测常见的多重耐药基因型及Ⅰ、Ⅱ、Ⅲ类整合子和ISCR1,使用ERIC-PCR分析MDR-KP的基因型。结果68株MDR-KP对氨曲南、头孢类、喹诺酮类和除头孢他啶/阿维巴坦外的酶抑制类药物耐药率高,大部分药物耐药率大于80.0%。检出的主要超广谱β-内酰胺酶基因型为bla SHV型,主要碳青霉烯酶基因型为bla KPC型。68株MDR-KP中,44株检出Ⅰ类整合子,检出率为64.7%,未检出Ⅱ类和Ⅲ类整合子基因,15株MDR-KP检出ISCR1,检出率为22.1%。Ⅰ类整合子携带最常见的基因盒为aadA2(16/44,36.4%)和aac(6′)-Ⅰb-cr5(14/44,31.8%),其次为dfrA12+aadA2(3/44,6.8%),ISCR1携带基因盒主要是qnrB91(9/15,60.0%)。ERIC-PCR结果显示,68株MDR-KP产生18种DNA指纹图谱,存在优势克隆型。结论Ⅰ类整合子和ISCRI广泛存在于该院临床分离的MDR-KP中,主要携带氨基糖苷类耐药基因盒(aadA2)及喹诺酮类耐药基因盒[aac(6′)-Ⅰb-cr5和qnrB91],介导多重耐药性。该院临床分离的MDR-KP存在优势克隆型,应加强医院内感染防控措施,有效控制此类细菌的播散。Objective To study the distribution characteristics and drug resistance gene carriage of integrons and insertion sequence common region 1(ISCR1)in multidrug-resistant Klebsiella pneumoniae(MDR-KP),and analyze the genotyping characteristics of MDR-KP using enterobacterial repetitive intergenic consensus polymerase chain reaction(ERIC-PCR)technology,in order to provide a reliable theoretical basis for strengthening the monitoring of drug resistance of Klebsiella pneumoniae and clinical medication.Methods A total of 68 non-repetitive MDR-KP strains isolated from clinical samples at Nanfang Hospital of Southern Medical University were collected as experimental strains.Bacterial DNA was extracted.Common multidrug-resistant genotypes and type Ⅰ,Ⅱ,and Ⅲ integrons and ISCR1 were detected by PCR,and the genotypes of MDR-KP were analyzed by using ERIC-PCR.Results The 68 MDR-KP strains had a high resistance rate to aztreonam,cephalosporins,quinolones,and enzyme inhibitor classes except ceftazidime/avibactam,and most of the resistance rates were greater than 80.0%.The main detected extended-spectrum β-lactamase(ESBL)genotype was bla SHV type,and the main carbapenemase genotype was bla KPC type.Among the 68 MDR-KP strains,type Ⅰ integrons were detected in 44 strains,with a detection rate of 64.7%.Type Ⅱ and Ⅲ integron genes were not detected.ISCR1 was detected in 15 MDR-KP strains,with a detection rate of 22.1%.The most common gene cassettes carried by type Ⅰ integrons were aadA2(16/44,36.4%)and aac(6')-Ⅰb-cr5(14/44,31.8%),followed by dfrA12+aadA2(3/44,6.8%).The main gene cassette carried by ISCR1 was qnrB91(9/15,60.0%).ERIC-PCR results showed that 68 MDR-KP strains produced 18 DNA fingerprint patterns,and there was a dominant clone type.Conclusion Type Ⅰ integrons and ISCR1 are widely present in MDR-KP isolated from clinical samples in this hospital,mainly carrying aminoglycoside resistance gene cassettes(aadA2)and quinolone resistance gene cassettes[aac(6')-Ⅰb-cr5 and qnrB91],mediating multidrug resista

关 键 词：多重耐药肺炎克雷伯菌 Ⅰ类整合子 插入序列共同区 基因盒 基因间重复共有序列聚合酶链反应 

分 类 号：R446.5[医药卫生—诊断学]