产KPC型碳青霉烯酶肺炎克雷伯菌的检测及感染现状

Detection of Klebsiella pneumoniae producing KPC carbapenemase and its infection status

目的通过对碳青霉烯类耐药肺炎克雷伯菌(CRKP)的检测及病例分析,了解CRKP对碳青霉烯类抗菌药物的耐药机制及感染现状,为临床抗感染治疗及院感控制提供依据。方法应用BD phoenixTM-100全自动细菌鉴定及药敏分析系统筛选耐亚胺培南或美罗培南的肺炎克雷伯菌,然后通过改良Hodge试验检测碳青霉烯酶表型,用PCR方法检测KPC、NDM-1和OXA-48碳青霉烯酶耐药基因。结果 71株CRKP改良Hodge试验阳性56株,阳性率为78.9%,PCR结果显示:71株CRKP中有53株检测出blaKPC-2基因、8株blaNDM-1基因、2株blaOXA-48基因;标本来源主要见于ICU、肾内科和神经内科等病房的痰液、尿液和引流液标本;药敏结果显示:所分离的71株CRKP除了对阿米卡星、替加环素和多粘菌素的耐药率较低外,对其他抗菌药物的耐药率均>70%。结论 CRKP临床分布较为广泛,多药耐药严重,其耐药基因以产KPC-2型为主,但同时还出现了NDM-1和OXA-48基因型,应加强监控。

Objective Detection and analysis of cases to carbapenem resistant Klebsiella pneumoniae（CRKP）.Understanding the resistance mechanism and infection status of CRKP antibacterial to carbopenems.Provide the basis for the clinical anti infection treatment and hospital infection control.Methods The application of BD phoenixTM-100 automatic bacteria identification and drug sensitivity analysis system for screening of Klebsiella pneumoniae resistant to imipenem or meropenem,and then through the modified Hodge test for the detection of carbapenemases phenotype of carbapenems.KPC,NDM-1and OXA-48 carbapenemase resistancegene detected by PCR.Results 71 strains of CRKP modified Hodge test,56 were positive,the positive rate was 78.9%.PCR showed that there were 53 strains in 71 strains CRKP detect blaKPC-2gene,8strains blaNDM-1,2strains blaOXA-48genes;Specimen source mainly in urine,sputum and drainage fluid which from ICU,renal medicine and neurology ward.The drug sensitivity results showed that in addition to the low resistance to amikacin,tigecycline and polymyxin,71 strains of isolates were resistant to other antimicrobial agents70%.Conclusion CRKP clinical distribution is more extensive,multi drug resistance is serious.Resistance gene is mainly produced KPC-2,NDM-1and OXA-48 also appeared at the same time.We should strengthen the monitoring with them.