肺炎克雷伯菌临床分布及耐药特性比较和KPC基因表达分析

Clinical Distribution, Drug Resistance Characteristics and KPC Gene Expression Analysis of Klebsiella Pneumonia

目的了解肺炎克雷伯菌在不同医院的临床分布及耐药特点,初步分析KPC基因表达状况,为合理选药提供依据。方法分别对两家医院2015年临床送检的所有样本进行病原菌分离鉴定和药敏试验,比较分析样本来源及科室分布特点,并以KB法验证其耐药结果,选出所有耐亚胺培南和美罗培南的菌株,检测其KPC基因的表达状况。结果分别分离出细菌:A院1 694株和B院5 075株,其中肺炎克雷伯菌A院286株和B院524株;主要分布于重症监护病房和呼吸科;菌株主要源自痰液、尿液和血液样本。耐药率排名A院前五位抗菌药物依次为复方磺胺甲唑、氨苄西林、呋喃妥因、氨苄西林/舒巴坦和哌拉西林;B院前五位抗菌药物依次为复方磺胺甲唑、氨苄西林、呋喃妥因、氨苄西林/舒巴坦和头孢唑啉。耐亚胺培南和美罗培南的菌株,部分表达KPC基因。结论两家医院肺炎克雷伯菌临床科室及标本类型分布特点相近,耐药谱略有差异。提示应以呼吸科和ICU的呼吸道感染作为监测重点,依据耐药基因表达情况合理选择用药。

Objective To investigate the clinical distribution and drug resistance characteristics of Klebsiella pneumonia in different hospitals, to analyze KPC gene, and to provide the basis for rational drug selection. Methods The pathogenic bacteria were isolated from clinical samples and identified by the two hospitals in 2015 respectively. The sample characteristics in clinical departments and type distribution were investigated. The results about drug resistance were verified with K-B method. All the Klebsiella pneumonia resistant to imipenem and meropenem were selected, of which the KPC genes were detected by PCR. Results The 5 075 and 1 694 strains bacteria were isolated from two hospitals respectively, including 524 strains Klebsiella pneumoniae and 286 strains respectively, which distributed mainly in ICU and respiratory department and from sputum, urine and blood samples. The drug resistance of Klebsiella pneumoniae in Tianjin Fourth Hospital were compound sulfamethoxazole, ampicillin, nitrofurantoin, ampicillin / sulbactam and piperacillin in order, while those in the other hospital were compound sulfamethoxazole, ampicillin, nitrofurantoin, ampicillin / sulbactam and cefazolin orderly. Some Klebsiella pneumoniae resistant to imipenem and meropenem could express the KPC gene. Conclusion The distribution characteristics and sample types of the two hospitals were similar, and the drug resistance spectrum was slightly different. These indicated that the respiratory tract infection in the respiration department and ICU should be paid attention to, and the rational drug was selected according to the drug resistance gene expression.