NICU耐碳青霉烯肺炎克雷伯菌耐药及多位点序列分析

Drug resistance and multilocus sequence analysis of carbapenem-resistant Klebsiella pneumoniae strains in NICU

目的分析NICU耐碳青霉烯肺炎克雷伯菌(CRKP)耐药及同源性,为临床防控CRKP提供实验依据。方法收集2016年1-12月某教学医院NICU首次分离的CRKP,使用PCR方法检测常见ESBLs基因(SHV、TEM、CTX-M1、CTX-M2、CTX-M8、CTX-M9)、AmpC酶基因(HAD、CMY)、碳青霉烯酶基因(KPC、NDM、SME、GES、VIM、IMP、OXA-48)和多粘菌素耐药基因MCR-1等,并采用多位点序列分析(MLST)方法分析同源性。结果共收集44株CRKP,KPC-2基因携带率为100%,DHA-1携带率为70.5%,CTX-M基因携带率为68.2%,MLST共有4类分型,ST11型35株,ST48型6株,ST134型1株,未分型4株。结论 NICU病区分离CRKP均为多重耐药,NICU以携带KPC-2基因的ST11型菌株流行为主,应规范抗菌药物使用,加强消毒隔离措施,控制流行传播。

OBJECTIVE To observe the drug resistance and homology of carbapenem-resistant Klebsiella pneumoniae（CRKP）strains isolated from NICU so as to provide experimental basis for clinical prevention and control of CRKP strains.METHODS The CRKP strains that were initially isolated from NICU of a teaching hospital from Jan2016 to Dec 2016 were collected.The common ESBLs genes（SHV,TEM,CTX-M1,CTX-M2,CTX-M8,CTXM9）,AmpC enzyme genes（HAD,CMY）,carbapenemase genes（KPC,NDM,SME,GES,VIM,IMP,OXA-48）and polymyxin resistance genes such as MCR-1 were detected by using PCR,and the homology was analyzed by means of multilocus sequence analysis.RESULTS Of totally 44 strains of CRKP,100% carried with KPC-2 gene,70.5%carried with DHA-1 gene,68.2%carried with CTX-M gene.The MLST showed that the strains were classified into totally 4 types and there were 35 strains of ST11,6 strains of ST48,1 strain of ST134 and 4 untyped strains.CONCLUSION All of the CRKP strains that are isolated from the NICU ward are multidrug-resistant,the type ST11 strains that carry with KPC-2 gene are prevalent in the NICU.It is necessary to reasonably use antibiotics and strengthen disinfection and isolation measures so as to control the prevalence and spread.