头孢他啶/阿维巴坦耐药CRKP临床分离菌株的分子流行病学特征  

Molecular epidemiological characteristics of clinical isolates of CRKP resistant to ceftazidime/avibactam

作　　者：张文震 邓雅杰 胡火利 曾凌 刘蓬 魏丹丹[4] 徐新平 黎萍 康秀华[6] ZHANG Wenzhen;DENG Yajie;HU Huoli;ZENG Ling;LIU Peng;WEI Dandan;XU Xinping;LI Ping;KANG Xiuhua(The First Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330036,China)

机构地区：[1]南昌大学第一附属医院呼吸与危重症医学科,江西南昌330036 [2]南昌大学第一附属医院胸外科,江西南昌330036 [3]南昌大学第一附属医院感染控制中心,江西南昌330036 [4]南昌大学第一附属医院检验中心,江西南昌330036 [5]南昌大学第一附属医院江西省呼吸疾病研究所,江西南昌330036 [6]南昌大学第一附属医院感染控制中心,江西省重大公共卫生事件医学中心,传染病防治江西省重点实验室,江西南昌330036

出　　处：《中华医院感染学杂志》2025年第5期641-646,共6页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(82160553);江西省卫生健康委员会科技计划基金资助项目(202130167)。

摘　　要：目的 分析头孢他啶/阿维巴坦耐药(简称CZA)的耐碳青霉烯肺炎克雷伯菌(CRKP)临床分离菌株分子流行病学特征。方法 选取2022年1月-2023年12月南昌大学第一附属医院住院患者首次分离的非重复CZA耐药的CRKP 63株和随机选取CZA敏感的CRKP 50株,对药物敏感性进行分析。同时,采用聚合酶链反应(PCR)检测细菌耐药基因、毒力基因及荚膜血清型。采用脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)等分子生物学技术,分析以上菌株分子流行病学特性。结果 CZA耐药的CRKP菌株主要分离于痰液(n=45,71.43%)。药敏结果显示CZA耐药菌株对阿米卡星、氨曲南及米诺环素的耐药率低于CZA敏感菌株(P<0.05),CZA耐药菌株对替加环素的耐药率高于敏感菌株(P<0.05)。CZA耐药CRKP菌株中bla_(KPC)、bla_(NDM)、bla_(SHV-1)、bla_(TEM-1)、bla_(CTX-M)、bla_(qnrS)、bla_(acc(6′)-Ib)、bla_(rmtB)基因携带率较高。荚膜血清型K64型(n=18,28.57%)检出最多,CZA耐药CRKP菌株中ST11(n=25,39.68%)为优势流行菌株。结论 CZA耐药CRKP菌株以ST11型为主,均携带多种耐药基因及毒力基因,应加强防控。CZA耐药菌株对替加环素的耐药率较敏感组高,因此临床治疗时需要格外注意。OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapenem-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43%)were isolated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-resistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P<0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P<0.05).The carrying rates of bla_(KPC),bla_(NDM),bla_(SHV-1),bla_(TEM-1),bla_(CTX-M),bla_(qnrS),bla_(acc(6′)-Ib)and bla_(rmtB)genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57%)was dominant.ST11(n=25,39.68%)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

关 键 词：头孢他啶/阿维巴坦 耐碳青霉烯肺炎克雷伯菌 耐药性 毒力 分子流行病学 

分 类 号：R378.996[医药卫生—病原生物学]