2018-2020年河北省儿童医院碳青霉烯类耐药肺炎克雷伯菌的耐药特征分析  

Antimicrobial resistance patterns of carbapenem-resistant Klebsiella pneumoniae strains isolated from Hebei Children’s Hospital from 2018 to 2020

作　　者：于文静[1] 李梅[1] 郭映辉[1] 徐茜茹 李圆龙 王启[2] YU Wenjing;LI Mei;GUO Yinghui;XU Qianru;LI Yuanlong;WANG Qi(Department of Laboratory Medicine,Hebei Children’s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院检验科,石家庄050031 [2]北京大学人民医院检验科

出　　处：《中国感染与化疗杂志》2025年第2期181-186,共6页Chinese Journal of Infection and Chemotherapy

基　　金：河北省医学科学研究课题计划(20240777);2025年政府资助临床医学优秀人才培养项目(ZF2025313)。

摘　　要：目的 了解儿童患者分离的碳青霉烯类耐药肺炎克雷伯菌(CRKP)的耐药特性和分布特征,为儿童CRKP感染的预防和治疗以及感染控制提供依据。方法 收集2018年1月-2020年12月河北省儿童医院临床分离的182株CRKP,并采用MALDI-TOF MS鉴定细菌。采用聚合酶链反应检测碳青霉烯酶基因(bla_(KPC)、bla_(NDM)、bla_(IMP)、bla_(VIM)、bla_(OXA-48))。采用多位点序列分型(MLST)对菌株进行同源性分析。结果 182例感染CRKP的患儿主要为婴儿(>28 d~<1岁),占49.45%(90/182);其次为新生儿(≤28 d),占36.26%(66/182)。182株CRKP主要来源于痰液(50.55%,92/182)、血液(15.93%,29/182)和尿液(13.19%,24/182);主要分布在新生儿科(30.22%,55/182)、普外科(21.43%,39/182)、心外科(13.19%,24/182)和重症科(11.54%,21/182)。药敏结果显示182株CRKP对头孢吡肟、头孢他啶、哌拉西林-他唑巴坦和头孢哌酮-舒巴坦耐药率为100%;对氨曲南的耐药率为97.8%;对阿米卡星、环丙沙星和左氧氟沙星的耐药率分别为71.4%、81.9%和75.8%;对多西环素的耐药率为69.2%;对替加环素的耐药率较低,为2.7%。碳青霉烯酶基因主要为bla_(KPC-2)(73.63%,134/182),其次为bla_(NDM-5) (15.38%,28/182)和bla_(NDM-1) (11.54%,21/182)。MLST共鉴定出15种不同的序列型,其中最常见的分型是ST11型(72.53%,132/182);其次为ST17型(11.54%,21/182)。结论 该院临床分离的CRKP耐药情况严重,临床应尽量根据药敏结果选用敏感药物,以减少耐药菌株的出现。携带bla_(KPC-2)基因的ST11型CRKP可能已在医院内播散,应采取有效的控制措施,避免耐药菌株进一步扩散。Objective To investigate the antimicrobial resistance patterns of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains isolated from children for better prevention,treatment,and control of CRKP infections in children.Methods A total of 182 clinical CRKP strains were collected between January 2018 and December 2020 in Hebei Children’s Hospital.All CRKP strains were identified by matrix-assisted laser desorption ionization-time of flight(MALDI-TOF)mass spectrometry.The common carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM,blaOXA-48)of CRKP isolates were studied by PCR.Multilocus sequence typing(MLST)was performed for homology analysis.Results The 182 children infected with CRKP were mainly infants(>28 days to<1 years),accounting for 49.45%(90/182),followed by newborns(≤28 days),accounting for 36.26%(66/182).The main source of the 182 CRKP isolates was sputum(50.55%,92/182),blood(15.93%,29/182),and urine(13.19%,24/182).The strains were mainly isolated from patients in neonatology(30.22%,55/182),general surgery(21.43%,39/182),cardiac surgery(13.19%,24/182),and intensive care unit(11.54%,21/182).Antimicrobial susceptibility testing showed that all of the 182 CRKP strains were resistant to cefepime,ceftazidime,piperacillin-tazobactam,and cefoperazone-sulbactam(100%).Overall,97.8%,71.4%,81.9%,75.8%,69.2%,and 2.7%of the strains were resistant to aztreonam,amikacin,ciprofloxacin,levofloxacin,doxycycline,and tigecycline,respectively.The prevalence of carbapenemase gene blaKPC-2 was the highest(73.63%,134/182),followed by blaNDM-5(15.38%,28/182),and blaNDM-1(11.54%,21/182).A total of 15 different sequence types(ST)were identified by MLST,of which ST11 was the most common type(72.53%,132/182),followed by ST17(11.54%,21/182).Conclusions CRKP isolates in Hebei Children’s Hospital showed high level resistance to antimicrobial agents.Antimicrobial therapy should be prescribed cautiously according to the results of antimicrobial susceptibility testing to avoid the emergence of resistant strains.KPC-2-producing ST11 type

关 键 词：儿童 碳青霉烯类耐药肺炎克雷伯菌 耐药性 多位点序列分型 

分 类 号：R378.996[医药卫生—病原生物学]