呼吸机相关性肺炎ST11型CR-KP对替加环素敏感性与其毒力基因相关性的分析  

Analysis on the correlation between the sensitivity of ventilator-associated pneumonia ST11 CR-KP to tigecycline and its virulence factors

作　　者：陈鑫伟 屠艳烨 高晖 邬兴炳 赵荣青 闫继亮 吴镝宇 CHEN Xinwei;TU Yanye;GAO Hui;WU Xingbing;ZHAO Rongqing;YAN Jiliang;WU Diyu(Department of Clinical Laboratory,Ningbo Medical Center Lihuili Hospital,Ningbo 315046,China;不详)

机构地区：[1]宁波大学附属李惠利医院(宁波市医疗中心李惠利医院)检验科,315046 [2]宁波大学附属李惠利医院(宁波市医疗中心李惠利医院)感染科,315046 [3]温州医科大学检验医学院生命科学学院

出　　处：《浙江医学》2025年第4期362-368,I0006,共8页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023KY1042、2024KY292);宁波市科技计划项目(2022J255)。

摘　　要：目的分析引发呼吸机相关性肺炎(VAP)的序列分型11(ST11)型碳青霉烯耐药肺炎克雷伯菌(CR-KP)对替加环素的敏感性及其毒力基因,为ST11型CR-KP的医院感染防控及临床治疗提供参考依据。方法回顾性选取2023年1至12月宁波市医疗中心李惠利医院重症监护室VAP患者痰液来源肺炎克雷伯菌150株,筛选出ST11型CR-KP 65株,检出率43.33%。采用聚合酶链反应检测其毒力基因及耐药基因;利用VITEK-2 Compact检测常用临床药物敏感性;并用基质辅助激光解吸电离飞行时间质谱仪进行菌株的同源性分析。结果65株ST11型CR-KP对替加环素的耐药率为13.85%(9/65),其中替加环素中介组和耐药组rmpA-2和peg-344携带率高于替加环素敏感组,差异均有统计学意义(均P<0.05);替加环素中介组和耐药组blaTEM携带率高于替加环素敏感组,差异均有统计学意义(均P<0.05);65株ST11型CR-KP被分为4个簇;且发现3株携带pLVPK样(pLVPK-like)毒力质粒的CR-KP,携带率为4.62%(3/65);还分离出1株blaNDM-5阳性菌株,对头孢他啶/阿维巴坦天然耐药。结论本院已出现对替加环素耐药的高毒力ST11型CR-KP,应更加合理使用抗菌药物,在减少耐药现象发生的同时更需加强防控医院感染,减少pLVPK-like毒力质粒的传播。Objective To explore the correlation between the sensitivity of sequence type 11(ST11)carbapenemresistant Klebsiella pneumoniae(CR-KP)to tigecycline and its virulence factors in ventilator-associated pneumonia(VAP),in order to provide a reference for the prevention and control of hospitalization and clinical treatment of ST11 CR-KP.Methods A total of 150 strains of Klebsiella pneumoniae derived from the sputum of VAP patients in the Intensive Care Unit of Ningbo Medical Center Lihuili Hospital were retrospectively selected from January to December 2023,and 65 strains of ST11 CR-KP were screened,with a detection rate of 43.33%.The virulence genes and drug resistance genes were detected by polymerase chain reaction.The sensitivity of commonly used clinical drugs was detected by VITEK-2 Compact.The homology analysis of the strains was performed by matter-assisted laser desorption ionization time-of-flight mass spectrometry.Results The drug resistance rate of 65 ST11 CR-KP strains to tigecycline was 13.85%(9/65),among which,the carrying rates of rmpA-2 and peg-344 in tigecycline intermediate group and resistant group were higher than those of tigecycline sensitive group,with statistical significance(all P<0.05).The blaTEM carrying rates in tigecycline intermediate group and resistant group were higher than those of tigecycline sensitive group,and the differences were statistically significant(all P<0.05).The 65 strains of ST11 CR-KP were divided into four categories.Three strains of CR-KP carrying pLVPK-like virulence plasmid were found,and the carrying rate was 4.62%(3/65).A blaNDM-5 positive strain was also isolated,which was naturally resistant to ceftazidime/avibactam.Conclusion Tigecycline-resistant ST11 type CR-KP with high virulence has observed in the hospital.It is necessary to use antibiotics more rationally,reduce the occurrence of drug resistance,strengthen the prevention and control of nosocomial infection,and reduce the spread of pLVPK-like virulence plasmids.

关 键 词：呼吸机相关性肺炎 序列分型11型碳青霉烯耐药肺炎克雷伯菌 替加环素 pLVPK样毒力质粒 

分 类 号：R563.1[医药卫生—呼吸系统]