摘要
目的回顾性分析青岛大学附属泰安市中心医院2019至2020年CRKP的耐药机制及流行病学特点,为临床治疗CRKP感染提供理论依据。方法收集青岛大学附属泰安市中心医院2019至2020年检出的CRKP 47株。采用全自动微生物质谱仪进行菌株鉴定,采用全自动微生物药敏仪进行药敏试验。多粘菌素的药敏试验采用微量肉汤稀释法。PCR法检测常见β内酰胺类耐药基因(bla CTT、bla CTX-M1、bla CTX-M3、bla TEM、bla SHV、bla KPC-gp、bla KPC-qc、bla NDM-1、bla IMP-1、bla IMP-2、bla IMP-11、bla IMP-12、bla VIM-2、bla OXA-48、bla OXA-58)和多粘菌素耐药基因(bla MCR-1)。利用脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)进行同源性分析。结果头孢菌素类、碳青霉烯类和酶的抑制剂类药物的耐药率为100%,氟喹诺酮类和氨基糖苷类药物的耐药率在65.96%~82.98%,替加环素和多粘菌素的耐药率为0.0%。碳青霉烯酶基因中,bla KPC-2基因检出率最高,占95.74%,其中19.15%的菌株同时携带bla NDM-1基因。其他β-内酰胺酶基因中bla SHV基因检出率最高,占91.49%,其次为bla TEM基因,占82.98%。70.02%的菌株同时携带四种及以上β-内酰胺酶基因。MLST分析得到8个序列分型,以ST11型为主,占85.11%。PFGE聚类分析将实验菌株分为A~M 13个型别,以E1亚型为主,主要分布在神经外科监护室,且均为ST11型。结论该医院CRKP菌株对碳青霉烯类药物的耐药机制主要是携带bla KPC-2基因,其次是bla NDM-1基因。同时携带多种β-内酰胺酶基因,可能是CRKP泛耐药的原因。菌株以ST11型流行为主,并且该院神经外科监护室在一定时期内存在CRKP的暴发流行,医院应进一步加强CKKP的感染预防控制。
Objective To retrospectively analyze the mechanism of drug resistance and epidemio⁃logical characteristics of CRKP in Taian Central Hospital Affiliated to Qingdao University during 2019⁃2020,and to provide theoretical basis for clinical treatment of CRKP infection.Methods 47 strains of CRKP de⁃tected in 2019⁃2020 were collected.Bacterial strains were identified by automatic microbial mass spectrometer,and drug susceptibility test was carried out by automatic microbial drug sensitivity instrument.The drug sensitiv⁃ity test of polymyxin was performed by microbroth dilution method.The commonβ⁃lactam resistance genes(bla CTT、bla CTX⁃M1、bla CTX⁃M3、bla TEM、bla SHV、bla KPC⁃gp、bla KPC⁃qc、bla NDM⁃1、bla IMP⁃1、bla IMP⁃2、bla IMP⁃11、bla IMP⁃12、bla VIM⁃2、bla OXA⁃48、bla OXA⁃58)and polymyxin resistance genes(bla MCR⁃1)were detected by PCR.Homology analysis was performed by pulsed field gel electrophoresis(PFGE)and multi⁃site sequence typing(MLST).Results The drug resistance rate of cephalosporins,carbapenems and enzyme inhibitors was 100%,the drug resistance rate of fluoroquinolones and aminoglycosides was 65.96%~82.98%,and the drug resistance rate of tigacycline and polymyxin was 0.Among carbapenase genes,the detec⁃tion rate of bla KPC⁃2 gene was the highest,accounting for 95.74%,among which 19.15%strains carried bla NDM⁃1 gene at the same time.Among the otherβ⁃lactamase genes,the detection rate of bla SHV gene was the highest(91.49%),followed by bla TEM gene(82.98%).70.02%of the strains carried four or moreβ⁃lactamase genes simultaneously.MLST analysis obtained 8 sequence types,mainly ST11 type,accounting for 85.11%.The experimental strains were divided into 13 types from A to M by PFGE cluster analysis,mainly E1 subtype,mainly distributed in the neurosurgical ICU,and all of them are ST11 type.Conclusion The resistance mecha⁃nism of CRKP strain to carbapenems in this hospital was bla KPC⁃2 gene,followed by bla NDM⁃1 gene.The si⁃multaneous carrying of multipleβ⁃lactamase genes may be the cause of pandrug resistance of CRKP.ST11 was the predominant strain,and there was an outbreak of CRKP in the neurosurgical ICU of the hospital in a certain period of time.The hospital should further strengthen the prevention and control of CKKP infection.
作者
曹身云
史家文
朱莺莺
赵书平
张志军
Cao Shenyun;Shi Jiawen;ZHU Yingying;ZHAO Shuping;ZHANG Zhijun(Clinical Laboratory Center,Tai'an Central Hospital Affiliated to Qingdao University,Tai'an,Shandong,China,271000;Central Laboratory,Tai'an Central Hospital Affiliated to Qingdao University,Tai'an,Shandong,China,271000;Department of Critical Care Medicine,Tai'an Central Hospital Affiliated to Qingdao University,Tai'an,Shandong,China,271000)
出处
《分子诊断与治疗杂志》
2025年第8期1589-1592,共4页
Journal of Molecular Diagnostics and Therapy
基金
山东省保健科技协会科学技术课题(SDBJKT20180033)
泰安市科技创新发展项目(2023NS406)
青岛大学附属泰安市中心医院苗圃培育项目(2022MPM01)。
关键词
耐碳青霉烯肺炎克雷伯菌
耐药机制
流行病学特点
Klebsiella pneumoniae
Genes
Pulsed⁃field gel electrophoresis
Multilocus sequence typing
