摘要
目的明确耐碳青霉烯酶产气克雷伯菌株(carbapenem-resistant Klebsiella aerogenes,CRKA)对碳青霉烯类抗菌药物耐药机制。方法收集2022—2023年浙江省两家医院分离的产气克雷伯菌,通过药敏实验筛选CRKA菌株,应用PCR筛查碳青霉烯耐药相关基因(bla_(KPC)、bla_(NDM)、bla_(IMP)和bla_(OXA-48)),通过药敏试验、接合试验和全基因组测序等方法明确CRKA菌株对碳青霉烯类抗菌药物耐药机制。同时基于全基因组单核苷酸多态性(single-nucleotide polymorphism,SNP)对CRKA进行系统发育分析。结果本研究共鉴定出9株携带bla_(NDM)基因的CRKA菌株,所有菌株对包括碳青霉烯类抗菌药物在内的多种抗菌药物耐药,仅对阿米卡星和多黏菌素敏感,均为多重耐药菌。所有菌株携带bla_(NDM)基因,且该基因均位于质粒,可成功接合转移入大肠埃希菌J53,提示该耐药基因存在质粒传播风险。系统发育分析发现,产气克雷伯菌主要在临床环境中发生克隆传播。结论bla_(NDM)基因是介导CRKA菌株对碳青霉烯类抗菌药物耐药的主要原因。临床应注意CRKA菌株存在院内感染暴发流行可能,持续筛查和监测尤为重要。
Objective To clarify the resistance mechanism of the CRKA(carbapenem resistant Klebsiella aerogenes,CRKA)strain to carbapenem antibiotics.Methods Collected Klebsiella aerogenes strains isolated from two hospitals in Zhejiang Province from 2022 to 2023,screened for CRKA strains through drug sensitivity experiments,and used PCR to screen for carbapenem resistance-related genes(bla_(KPC)、bla_(NDM)、bla_(IM) and bla_(OXA-48)),through drug sensitivity testing,conjugation testing,and whole genome sequencing.Simultaneously,a phylogenetic analysis was conducted on CRKA-producing NDM based on genome-wide single nucleotide polymorphism(SNP).Result As a result,a total of 9 CRKA strains carrying the bla_(NDM) gene were identified in this study.All strains were resistant to multiple antibiotics,including carbapenems,and only sensitive to amikacin and polymyxin,making them multidrug-resistant bacteria.All strains carried the bla_(NDM) gene,which was located in plasmids and could be successfully transferred into Escherichia coli J53,indicating the risk of plasmid transmission of this antibiotic resistance gene.Phylogenetic analysis revealed that Klebsiella aerogenes primarily undergoes clonal transmission in clinical environments.Conclusion The bla_(NDM) gene is the main factor mediating the resistance of CRKA strains to carbapenem antibiotics.Clinical attention should be paid to the possibility of outbreak and spread of hospital-acquired infections with the CRKA strain,and continuous screening and monitoring are particularly important.
作者
寿晓玲
王佳庆
苏芳
沈蓓琼
张淑琦
Shou Xiaoling;Wang Jiaqing;Su Fang;Shen Beiqiong;Zhang Shuqi(Department of Laboratory Medicine,Shaoxing Traditional Chinese Medicine Hospital,Shaoxing 312000;Department of Laboratory Medicine,Shaoxing Central Hospital Medical Community General Hospital,Shaoxing 312000;Inspection Center of Zhejiang Provincial People’s Hospital,Hangzhou 310014;Department of Laboratory Medicine,Haining Central Hospital,Haining 314400)
出处
《中国抗生素杂志》
北大核心
2025年第8期944-949,共6页
Chinese Journal of Antibiotics
关键词
耐碳青霉烯类产气克雷伯菌
NDM
质粒
进化分析
耐药机制
Carbapenem-resistant Klebsiella aerogenes
NDM
Plasmid
Evolutionary analysis
Drug resistance mechanism
