摘要
目的分析多重耐药肺炎克雷伯菌中碳青霉烯酶的检测情况。方法于2021年1月至2022年11月将南阳市中心医院分离的肺炎克雷伯菌(多重耐药菌)78株纳入研究,行碳青霉烯酶表型试验,得出碳青霉烯酶基因,再行聚合酶链反应,同时对于扩增产物做DNA测序,最终确定基因型。结果78株肺炎克雷伯菌中一共有超广谱β内酰胺酶(ESBL)阳性菌48株,ESBL阴性菌30株,产ESBL阳性率61.54%。药敏分析结果显示:产ESBL株对于第一和第三代头孢菌素与青霉素类抗菌药物耐药率较高,除了头孢替坦只有19.59%,其他都在90.00%以上;对于单环类氨曲南耐药率达到100.00%;对于亚胺培南的耐药率低,为1.01%,敏感性最高,为99.64%。除了亚胺、厄他和美罗培南以及左氧氟沙星之外,产ESBL株均较非产ESBL株耐药率高。78株肺炎克雷伯菌,Hodge试验阳性共有10株(12.82%),阴性共68株(87.18%)。在10株阳性菌中,金属酶试验阳性的仅有1株。10株Hodge试验阳性菌用PCR扩增之后确定的菌株有4株,其中的3株为KPC型,阳性率3.85%,有1株为IMP型,阳性率1.28%。经过PCR产物测序结果显示,这3株产KPC型菌株全部携带KPC-2基因亚型,1株产IMP型菌株携带的基因亚型为IMP-4。结论在肺炎克雷伯多重耐药菌中碳青霉烯酶还有较高的检出率,主要为产KPC-2型,因此在临床应用时尤其要注意,合理应用碳青霉烯类药物治疗,尽可能减少耐药菌株,使治疗效果提高,值得借鉴。
Objective To analyze the detection of Carbapenem enzyme in multi drug resistant Klebsiella pneumoniae.Methods From January 2021 to November 2022,78 strains of Klebsiella pneumoniae(multi drug resistant bacteria)isolated from our hospital were included in the study,and then the drug sensitivity results were carefully analyzed.The specific measures were as follows:first,Carbapenem enzyme phenotype test was carried out to see whether Carbapenem enzyme gene could be obtained.If Carbapenem enzyme gene could be obtained,polymerase Chain reaction was carried out.At the same time,DNA sequencing was also carried out for the amplified product,and finally the genotype was determined.Results A total of 48 positive extendedspectrum β-lactamase(ESBL)and 30 negative ESBL strains were discovered;the positive rates of ESBL producing strains were 61.54%.The results of drug sensitivity analysis showed that ESBL producing strains have particularly high resistance to first and third generation cephalosporins and penicillin antibiotics,mostly concentrated at over 90%,except for cefotetan,which is only 19%;The resistance rate to monocyclic aztreonam reaches 100%;The resistance rate to ampicillin/sulbactam is also high,at 94%;The resistance rate to imipenem is the lowest at 1%,and the sensitivity is the highest at 99%;The resistance rate to ertapenem is 8%,and the sensitivity is 77%.Except for imine,etapenem,meropenem,and levofloxacin,ESBL producing strains have a higher resistance rate than non ESBL producing strains.Among 78 klebsiella pneumonia strains,10 positive strains of Hodge test(12.82%)and 68 negative strains(87.18%)were recorded.Among 10 positive strains,just one positive case of metalloenzeme test was discovered.After PCR amplification,4 strains were confirmed with carbapenemases bacterial strains,including 3 KPC strains(3.85%)and one IMP strains(1.28%).PCR product sequencing results indicated that 3 KPC strains were carried with KPC-2 genotype;one IMP strain was carried with IMP-4 genotype.Conclusion In Klebsiella pneumoniae multi drug resistant bacteria,Carbapenem enzyme has a high detection rate,mainly producing KPC-2.Therefore,in clinical application,special attention should be paid to the rational use of Carbapenem drugs to reduce drug-resistant strains as far as possible,so as to improve the treatment effect,which is worth learning.
作者
董娅
DONG Ya(Department of Laboratory,Nanyang Central Hospital,Nanyang Henan 473000,China)
出处
《临床研究》
2023年第12期133-135,共3页
Clinical Research
关键词
多重耐药
肺炎克雷伯菌
碳青霉烯酶
klebsiella pneumonia
multi-drug resistant
carbapenemases
