我国携带KPC基因耐药菌流行现况分析

Epidemiological analysis of KPC-positive bacteria in China

目的分析我国产肺炎克雷伯菌碳青霉烯酶（KPC）阳性菌的流行病学特征,探讨我国携带KPC阳性菌流行特征及耐药机制。方法收集2009~2015年报道我国blaKPC研究文献,对KPC阳性菌株种类与地区分布、感染来源、耐药谱和转移机制进行流行病学分析。结果我国共有21个省市报道bla_（KPC）阳性菌株,其中浙江最多,占43.51%（P〈0.01）;阳性菌以肺炎克雷伯菌最多,占87.86（P〈0.01）;感染阳性菌的患者男性居多（P〈0.05）;患者所在科室以ICU病区最多,占70.51%（P〈0.01）;痰液标本分离bla_（KPC）阳性菌最多,占45.62%（P〈0.01）;bla_（KPC）阳性菌对头孢菌素类、碳青霉烯类、氨基糖苷类抗生素耐药率普遍较高,对多黏菌素、替加环素的耐药率较低;产KPC-2酶或合并多种β-内酰胺酶和外膜蛋白缺失是导致碳青霉烯类抗生素耐药的重要原因。结论携带KPC基因的耐药菌感染已成为全球性的公共卫生问题,需要深入研究其发生发展规律。

Objective To analyze the published research papers about Klebsiella pneumoniae carbapenemases（ KPC）-positive bacteria in China in order to shed light on the epidemiological characteristics,drug-resistance mechanism and transmission of the KPC-positive bacteria. Methods The published papers about domestic blaKPCwere collected and analyzed according to the species,regional distribution,infectious source,drug-resistance mechanism and transmission.Results KPC-positive bacteria were reported in 21 provinces（ regions） and / or municipalities in China. Research reports from Zhejiang Province ranked first and accounted for 43. 51%（ P〈 0. 01）. K. pneumoniae was dominating among the KPCpositive bacteria（ P〈 0. 01） reported. Male patients infected wtih KPC-positive bacteria were the largest group among the reported patients（ P〈 0. 05）. Most of the infectious occurred in intensive care units（ ICU）（ P〈 0. 01） or with sputum samples（ P〈 0. 01）. KPC-positive bacteria found in China had relatively higher resistance to antibiotics of cephalosporins,carbopenems and aminoglycosides and the lowest resistance to polymyxin and tigecycline. Presence of KPC-2,a combination of a variety of β-lactamases and loss of outer membrane protein were an important couse of resistance. Conclusion Antibiotic resistant bacteria with KPC gene have become a global public health concern,which require more studies to find out how they happen and are transmitted in the future.