骨科感染患者病原菌产肺炎克雷伯菌碳青霉烯酶的检测研究

Detection of Klebsiella pneumoniae carbapenemase produced by pathogenic bacteria from patients with infection in orthopedics department

目的对骨科患者感染的大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌、弗氏柠檬酸杆菌、褪色沙雷菌等进行肺炎克雷伯菌碳青霉烯(KPC)酶检测,为合理使用碳青霉烯类抗菌药物提供依据。方法选择2008年1月-2011年2月骨科感染患者分离的革兰阴性杆菌包括大肠埃希菌110株、阴沟肠杆菌15株、肺炎克雷伯菌145株、弗氏柠檬酸杆菌5株、褪色沙雷菌3株等共278株病原菌采用VITEK-2Compact、K-B纸片法进行药敏试验,以亚胺培南、美罗培南、厄他培南为检测药物,筛选出碳青霉烯类耐药菌株,用改良的Hodge试验筛选、聚合酶链反应(PCR)扩增,确认产KPC酶及基因分型。结果在278株病原菌中,对碳青霉烯类耐药的大肠埃希菌9株、阴沟肠杆菌10株、肺炎克雷伯菌16株,共35株进行改良Hodge试验,肺炎克雷伯菌阳性2株,2株肺炎克雷伯菌PCR扩增出现目的基因片段,其余菌株改良Hodge试验全部阴性。结论该项研究除2株肺炎克雷伯菌中发现目的基因片段,其他病原菌未发现产KPC酶的菌株。

OBJECTIVE To investigate Klebsiella pneumoniae carbapenemase（KPC） production in clinical isolates of Eseherichia coli （ECO）, Enterobact cloacae （ECL） , Klebsiella pneurnoniae （KPN）, Citro freundii （CFE） and Serratia marcescens （SMA） in orthopaedic infected patients to provide the basis, for reasonably using the carbapenems are antibiotics. METHODS Choose January 2008 until 2011 February orthopaedic infection were separate negative bacillus including ECO（110 strains）, ECL（15 strains）, KPN（145 strains）, CFR（5 strains of）, SMA （3 strains）, the total pathogen 278 VITEK2-compact, disk diffusion test（k-b） to imipenem meropenem and ertapenem, selected for testing drugs carbapenems with the modified Hodge test, polymerase chain reaction （PCR） augmentation confirm production KPC enzyme and genotyped. RESULTS 278 strains in of pathogens carbapenems are the resistance of ECO 9 strains, ECL 10 strains, KPN 16 strains, 35 strains of modified Hodge test, positive two strains of KPN, two strains of KPN polymerase chain reaction （PCR） augmentation appear purpose gene fragments, and the rest modified Hodge test all negative. CONCLUSION No KPC-2 isolate was found, purpose gene fragment is not found in other pathogens of enzyme KPC-2. According to domestic similar research report, at present our country mainly produce KPC-2 give priority to, and produce KPC enzyme strains of bacteria existing regional differences.