碳青霉烯类耐药肺炎克雷伯菌药物敏感性及bla_(KPC)基因检出率

Susceptibility and prevalence of bla_(KPC) gene in carbapenem-resistant Klebsiella pneumoniae

目的了解复旦大学附属华山医院碳青霉烯类耐药肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)对常用抗菌药物的敏感性及bla_(KPC)基因的检出率。方法收集2014年1-12月临床分离的CRKP,微量肉汤稀释法测定CRKP对常用抗菌药物的敏感性;聚合酶链反应(PCR)扩增bla_(KPC)基因。结果共收集CRKP 205株,主要分离自呼吸道标本(76.1%,156/205)和尿标本(18.5%,38/205)。药敏试验结果显示,CRKP对大多数抗菌药物高度耐药,除对多黏菌素E、替加环素、甲氧苄啶-磺胺甲唑和阿米卡星的耐药率分别为1.5%、0.5%、51.0%和74.9%外,对其他抗菌药物的耐药率在85%~100%;87.8%(180/205)菌株为blaKPC基因阳性株。结论 CRKP对多黏菌素和替加环素之外的多数临床常用抗菌药物呈高度耐药;产KPC型碳青霉烯酶是CRKP对碳青霉烯类耐药最主要的耐药机制。

Objective To examine the antimicrobial susceptibility and prevalence of blaKPC gene in carbapenem-resistant Klebsiella pneumoniae （CRKP） strains isolated in Huashan Hospital, Fudan University. Methods The CRKP strains isolated in Huashan Hospital from January to December of 2014 were included in this study. The MICs of antibiotics were determined using CLSI broth dilution method. The blaKec gene was amplified by polymerase chain reaction （PCR）. Results A total of 205 CRKP strains were isolated, mainly from respiratory tract （76.1%, 156/205） and urine specimens （18.5%, 38/205）. AntimicrobiaI susceptibility test indicated that CRKP isolates had higher resistance rates （85% - 100%） to the antimicrobial agents except colistin （1.5%）, tigecycline （0.5%）, trimethoprim-sulfamethoxazole （51.0%） and amikacin （74.9%）. Most （87.8%, 180/205） of the CRKP strains were positive for blaKPC gene. Conclusions CRKP are mostly isolated from patients with lower respiratory tract infection and/or urinary tract infbction in Huashan Hospital. The strains were highly resistant to the antibacterial agents tested except colistin and tigecycline. Production ofKPC-type carbapenemase is the common mechanism of carbapenem resistance in these K. pneumoniae isolates.