多药耐药肺炎克雷伯菌15种抗菌制剂外排泵基因研究

Investigation of 15 kinds of drug efflux genes in multidrug-resistant Klebsiella pneumonia

目的调查一组多药耐药肺炎克雷伯菌(MDRKP)中抗菌制剂外排泵基因的存在情况。方法收集2008年8月-2010年5月浙江省杭州市和湖州市6所医院共47株MDRKP,采用聚合酶链反应(PCR)的方法分析15种抗菌制剂外排泵基因。结果 47株MDRKP共检出emrB、mdfA、ramA、qacE△1、oqxA、tehA、smr-Kpn、sugE、tetB、emrD和tetA 11种抗菌制剂外排泵基因,阳性率分别为100.00%、100.00%、100.00%、82.98%、80.85%、29.79%、8.51%、4.26%、4.26%、2.13%、2.13%,其余4种基因未检出;可分为10种阳性检出模式,其中以emrB+mdfA+ramA+oqxA+qacE△1阳性模式为主,占53.19%。结论携带这11种抗菌制剂外排泵基因是导致本组菌呈多药耐药的一个重要原因,在肺炎克雷伯菌同时检测这15种抗菌制剂外排泵基因为国内首次报道。

OBJECTIVE To investigate the distribution of 15 kinds of drug efflux genes in a group of multidrug-resistant Klebsiella pneumoniae（MDRKP）.METHODS From Aug 2008 to May 2010,a total of 47 strains of MDRKP were collected from 6 hospitals in Hangzhou and Huzhou in Zhejiang Province in China.Then,15 kinds of drug efflux genes were analyzed by PCR.RESULTS In 47 strains of MDRKP,11 kinds of drug efflux genes including emrB,mdfA,ramA,qacE△1,oqxA,tehA,smr-Kpn,sugE,tetB,emrD and tetA 11 were tested positive,the positive rates were 100.00%,100.00%,100.00%,82.98%,80.85%,29.79%,8.51%,4.26%,4.26%,2.13%,and 2.13%,respectively,but other 4 kinds of drug efflux genes were negative.Furthermore,10 kinds of positive modes were detected,and emrB＋mdfA＋ramA＋oqxA＋qacE△1 was the main mode,accounting for 53.19%.CONCLUSION Eleven kinds of drug efflux genes play an important role in the drug resistance to antimicrobials in this group of K.pneumoniae.It′s the first report in China to detect 15 kinds of drug efflux genes simultaneously in K.pneumoniae.