多药耐药肺炎克雷伯菌耐药元件检测的样本聚类分析

Sample cluster analysis of drug resistance determinants in multidrug-resistant Klebsiella pneumoniae

目的：研究多药耐药肺炎克雷伯菌（MDRKP）的菌株亲缘性，为临床预防其感染提供参考依据。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 ，进行102种耐药元件的 PCR 法检测，包括β-内酰胺类、氨基糖苷类、喹诺酮类、四环素、利福平与磺胺甲噁唑／甲氧苄啶药物耐药相关基因及可移动遗传元件，并对检测结果作样本聚类分析。结果47株 MDRKP 中共检出34种耐药元件，检出阳性率为2．1％～100．0％；样本聚类分析1、6和13～15号菌株为杭州市 A 医院的克隆传播；18～20号菌株为源自杭州市B 医院的克隆传播；29、32和31、33号菌株为杭州市 D 医院的克隆传播；35、37、38号菌株为湖州市 E 医院的克隆传播；39～42、45～47号菌株为杭州市 F 医院的克隆传播。结论对耐药元件检测结果进行样本聚类分析，是对跨地区和（或）跨年度的菌株进行亲缘关系研究的一种简捷方法，为追溯耐药菌传播途径提供了有效手段。

OBJECTIVE To study the affinity of the multidrug-resistant K lebsiella pneumoniae strains so as to pro-vide guidance for clinical prevention of infections .METHODS A total of 47 strains of multidrug-resistant K .pneu-moniae were collected from 6 hospitals of Hangzhou and Huzhou of Zhejiang province from Aug 2008 to May 2010 ,then 102 kinds of drug resistance determinants were detected by using PCR ,including β-lactams-resistance genes ,aminoglycoside-resistance genes ,quinolone-resistance genes ,tetracycline-resistance genes ,rifampicin-re-sistance genes ,and sulfamethoxazole-trimethoprim-resistance genes as well as mobile genetic elements ,and sample cluster analysis of the detection results was performed .RESULTS Totally 34 kinds of drug resistance determinants were detected positive in the 47 strains of multidrug-resistant K .pneumoniae ,with the positive rate ranging from 2 .1% to 100 .0% .The sample cluster analysis revealed that strain No .1 ,6 and strain No .13 to 15 were the clon-ally spread strains of hospital A in Hangzhou ,strain No .18 to 20 were the cloning spread strains of hospital B in Hangzhou ,strain No .29 ,32 and strain No .31 ,33 were the cloning spread strains of hospital D in Hangzhou . strain No .35 ,37 ,38 were the cloning spread strains of hospital E in Huzhou ,and strain No .39 to 42 ,45 to 47 were the cloning spread strains of hospital F in Huzhou .CONCLUSION The sample cluster analysis of the drug re-sistance determinants is a simple way to study the affinity of the transregional or multi-year strains ,offering an ef-fective method to trace the transmission routes of the drug resistant strains .