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耐碳青霉烯类肺炎克雷伯菌耐药基因分布情况及其同源性探讨

别立翰,马晨芸,蒋秀娣,陆志成   

  1. 上海中医药大学附属第七人民医院,上海中医药大学附属第七人民医院,上海中医药大学附属第七人民医院,上海中医药大学附属第七人民医院
  • 收稿日期:2018-09-17 修回日期:2018-12-10 出版日期:2019-02-25
  • 基金资助:
    上海中医药大学附属第七人民医院人才培养计划(项目编号:XX2016-06);项目名称:上海浦东新区卫生和计划生育委员会重要薄弱学科建设项目(项目编号:PW2br2007-01)

Distribution and Homology of Drug Resistance Genes of Carbapenem-resistant Klebsiella Pneumoniae

BIE Han,MA Cheng yun,JIANG Xiu di and LU Zhi cheng   

  1. Shanghai People''s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai People''s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai People''s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai People''s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
  • Received:2018-09-17 Revised:2018-12-10 Online:2019-02-25

摘要: 目的:了解对碳青霉烯类抗生素耐药的肺炎克雷伯杆菌(CR-KP)中碳青霉烯酶的主要类型及流行情况。方法:收集我院2016 年1月至2017年12月对厄他培南、亚胺培南或美罗培南药敏试验结果不敏感的CR-KP共34 株,根据CLSI M100S-27th文件的改良碳青霉烯灭活试验确证其是否为产酶菌株,通过PCR方法扩增5种碳青霉烯酶基因(bla KPC、bla IMP、bla OXA-48、bla VIM、bla NDM),PCR扩增产物进行测序明确基因型;通过脉冲场凝胶电泳对肺炎克雷伯菌进行同源性分析。结果:34株肺炎克雷伯菌经改良碳青霉烯灭活试验确证均为产酶菌株,PCR检测显示均为KPC-2型酶。脉冲场凝胶电泳(PFGE)结果显示34株菌可分为5组,其中1、2、4组为主要流行菌株。结论:院内存在以KPC-2为主要耐药基因的CR-KP克隆株的流行,且主要以重症医学科耐药株流行,34株菌间存在不同程度的亲缘关系。

Abstract: Objective:To understand the main types and prevalence of carbapenemases in Klebsiella pneumoniae(CR-KP) resistant to carbapenems. Methods:A total of 34 CR-KP strains were collected from our hospital from January 2016 to December 2017, which were insensitive to the results of drug susceptibility test of ertapenem, imipenem or meropenem. According to the modified carbapenem inactivation test of CLSI M100S-27th file, it was confirmed that they were enzyme-producing strains. Five carbapenemase genes (bla KPC、bla IMP、bla OXA-48、bla VIM、bla NDM)were amplified by PCR. PCR amplified products were sequenced and genotypes were identified. The homology of Klebsiella pneumoniae was analyzed by pulsed field gel electrophoresis. Results:Thirty-four strains of Klebsiella pneumoniae were confirmed to be enzyme-producing strains by modified carbapenem inactivation test, and all of them were KPC-2 enzyme by PCR detection. PFGE results showed that 34 strains could be divided into 5 groups, of which 1, 2 and 4 were the main epidemic strains. Conclusion:CR-KP clones with KPC-2 as the main drug resistance gene were prevalent in the hospital, and drug-resistant strains were prevalent in the department of critical medicine. There were 34 strains with different degrees of genetic relationship.