114株耐碳氢酶烯肺炎克雷伯杆菌耐药表型及基因分析
Drug-resistant phenotype and gene analysis of 114 strains of hydrocarbon resistant Klebsiella pneumoniae

贺立飞.114株耐碳氢酶烯肺炎克雷伯杆菌耐药表型及基因分析[J].内科急危重症杂志,2021,27(1):29-32

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DOI：10.11768/nkjwzzzz20210109

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基金项目:长沙市科技计划项目（No：kq1801189）

作者	单位	E-mail
贺立飞	湖南省宁乡市人民医院	hlfei6907@163.com

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中文摘要:

目的:分析114株耐碳氢酶烯肺炎克雷伯杆菌（CRKP）的耐药表型与基因型，为控制耐碳氢酶烯肺炎克雷伯杆菌传播及临床治疗提供依据。方法：选取住院患者痰样本分离的114株CRKP，采用VITECK2全自动细菌鉴定仪进行菌种鉴定并验证其对碳青霉烯的药敏性。采用改良碳青霉烯灭活法（mCIM法）检测CRKP的耐药表型；采用PCR法检测碳氢酶烯酶blaKPC、blaNDM、blaIMP、blaVIM、blaOXA 4耐药基因。结果： 114株CRKP经mCIM法检测阳性率为95.61%，耐药表型均为KPC型。耐药菌对青霉素类、头孢菌素类和碳青霉烯类药物的耐药率均在95%~100%；对氨基糖苷类、喹诺酮类、四环素类和氯霉素类药物的耐药率分别为70%~75%、82%~87%、90%~95%和80%~84%（均P<0.05）。经PCR检测，blaKPC基因阳性检出率为100%。脉冲凝胶电泳（PFGE）分子分型共分为13个谱型，优势型别为KPN01.005型（35株），各菌株间相似性系数达92.0％以上。结论：宁乡市人民医院CRKP的耐药十分严重，与其携带blaKPC耐药基因密切相关。应加强细菌耐药性监测和医院感染的监控。

英文摘要:

Objective: To analyze the drug-resistant phenotypes and genotypes of 114 strains of hydrocarbon-resistant Klebsiella pneumoniae (CRKP) to provide evidence for the control of the transmission and clinical treatment of K. pneumoniae. Methods: 114 CRKP strains isolated from sputum samples of hospitalized patients were selected, and VITECK2 automatic bacteria identification instrument was used to identify the strains and verify their drug sensitivity to carbapenem. The modified carbapenem inactivation method (mCIM) was used to detect the drug resistance phenotype of CRKP. The PCR was used to detect the resistance genes of blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA4. Results: The positive rate of 114 CRKP strains detected by mCIM was 95.61%, and the drug-resistant phenotypes were all KPC type. The drug resistance rates of drug-resistant bacteria to penicillins, cephalosporins and carbapenems were all 95%-100%. The drug resistance rates to aminoglycosides, quinolones, tetracyclines and chloramphenicol drugs were 70% to 75%, 82% to 87%, 90% to 95%, and 80% to 84% respectively (all P<0.05). After PCR, the positive detection rate of blaKPC was 100%. Pulse gel electrophoresis (PFGE) molecular typing was divided into 13 spectral types, the dominant type was KPNO1.005 (35 strains), and the similarity coefficient between strains was over 92.0%. Conclusion: The drug resistance of CRKP in our hospital is very serious, which is closely related to the blaKPC resistance gene. The surveillance of bacterial resistance and hospital infection should be strengthened.