摘要
目的 探讨老年重症患者肠道定植产KPC-2肺炎克雷伯菌的分子流行病学特征。方法 纳入2019年1月-2020年6月四川省中西医结合医院收治的进行直肠定植耐碳青霉烯革兰阴性菌筛查的老年重症患者,以分离出的68株产KPC-2肺炎克雷伯菌菌株作为研究样本。对菌株进行药敏性分析,采用聚合酶链式反应检测CTX-M、SHV、TEM-1β、RmtB、Arm、oqxAB、oqxA、oqxB、qnrB等耐药基因及allS、rmpA、mrkD、kfuBC、cf29a、fimH、ureA、uge等毒力基因情况。结果 68株产KPC-2肺炎克雷伯菌对所有β内酰胺类抗菌药物耐药,对喹诺酮类、氨基糖苷类、磺胺类等药物表现出较高程度的耐药。68株产KPC-2肺炎克雷伯菌检出CTX-M、SHV、TEM-1β、RmtB、Arm、oqxAB、oqxA、oqxB、qnrB基因,其中TEM-1β、oqxAB、oqxA、oqxB等基因检出率高于50%。入组68株产KPC-2肺炎克雷伯菌中,以毒力基因fimH、ureA、uge分布较为广泛,其次为rmpA、mrkD。结论 产KPC-2肺炎克雷伯菌临床菌株有其独特的分子生物学特征,这些特征决定其生物学功能及耐药性情况,对这些临床特征进行定期监测可对临床提供一定参考。
OBJECTIVE To investigate the molecular epidemiological characteristics of intestinal colonization of Klebsiella pneumoniae producing KPC-2 in elderly critically ill patients. METHODS Elderly critically ill patients who received screening for rectal colonization of carbapenem-resistant Gram-negative bacteria in Sichuan Integrated Traditional Chinese and Western Medicine Hospital from Jan 2019 to Jun 2020 were included in the study. The isolated 68 strains of Klebsiella pneumoniae producing KPC-2 were taken as the study samples, and drug susceptibility test was performed. Drug-resistant genes such as CTX-M, SHV, TEM-1β, RmtB, Arm, oqxAB, oqxA, oqxB and qnrB, virulence genes such as allS, rmpA, mrkD, kfuBC, cf29a, FimH, ureA and uge were detected by polymerase chain reaction. RESULTS The 68 strains of K pneumoniae producing KPC-2 were resistant to all beta-lactamases, and were highly resistant to quinolones, aminoglycosides, and sulfonamides. CTX-M, SHV, TEM-1β, RmtB, Arm, oqxAB, oqxA, oqxB, and qnrB were detected in the 68 strains of K pneumoniae producing KPC-2. The detection rates of TEM-1β, oqxAB, oqxA, and oqxB were higher than 50%. Virulence genes fimH, ureA, and mrkD were more common in the 68 strains of K pneumoniae producing KPC-2, followed by rmpA and mrkD. CONCLUSION K pneumoniae producing KPC-2 has unique molecular biological characteristic which determine its biological function and drug resistance. Regular monitoring of these clinical characteristics can provide reference for clinical practice.
作者
李春梅
王城城
范永秀
昌涛
马佳慧
皮晓琴
LI Chun-mei;WANG Cheng-cheng;FAN Yong-xiu;CHANG Tao;MA Jia-hui;PI Xiao-qin(Sichuan Integrated Traditional Chinese and Western Medicine Hospital,Chengdu,Sichuan 610041,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第16期2401-2405,共5页
Chinese Journal of Nosocomiology
基金
四川省中医药管理局面上项目(2021MS319)
四川省中医药管理局基金资助项目(2020LC0201)。
关键词
肺炎克雷伯菌
分子流行病学
耐药基因
毒力基因
老年重症患者
肠道定植
Klebsiella pneumoniae
Molecular epidemiology
Drug-resistant gene
Virulence gene
Elderly critically ill patients
Intestinal colonization
