重症监护病房耐亚胺培南肺炎克雷伯菌耐药基因检测

Detection of resistance gene of carbapenem-resistant Klebsiella pneumoniae from intensive care units

目的:对重症监护病房(ICU)出现的13株耐亚胺培南肺炎克雷伯菌的分子流行病学及耐药机制进行研究。方法:从ICU分离到13株对亚胺培南耐药肺炎克雷伯菌,采用琼脂稀释法检测包括亚胺培南在内的5种抗菌药物最低抑菌浓度(MIC);用聚合酶链反应(PCR)及耐药基因克隆测序方法研究细菌的耐药机制;用肠杆菌基因间重复性一致性序列-PCR分析菌株的分子流行病学。结果:13株肺炎克雷伯菌亚胺培南的MIC为16～1 024μg/ml;13株实验菌PCR产物克隆测序分析比对为blaKPC-2型和blaSHV型基因。结论:ICU连续出现13株耐亚胺培南肺炎克雷伯菌,KPC-2是引起细菌对亚胺培南耐药的主要原因,SHV型β-内酰胺酶同时参与多重耐药机制。

Objective：To investigate the molecular epidemiology and mechanism of carbapenem resistance of Klebsiella pneumoniae from intensive care units （ICU）. Methods：Thirteen strains of Klebsiella pneumoniae with carbapenem resistance were isolated from ICU. The minimum inhibitory concentrations（M1C） were detected by using agar-dilution, polymerase chain reaction（PCR） and cloning and sequencing of resistance genes were used to analyzed the resistant mechanism. Enterobacterial repetitive intergenic consensus-PCR was performed to analyze the molecular epidemiology. Results：The MICs of imipenem of 13 strains of KlebsieUa pneumoniae were from 16 to 1 024 μg/ml, which were blaKPC-2 and blaSHV using the PCR product cloning and sequencing method. Conclusions： Carbapenemase blaKPC-2 is the major factor of carbapenem resistance, and laetamase blaSHV participates multiple mechanisms of resistance.