耐碳青霉烯类肺炎克雷伯菌的药敏结果及耐药基因

Antimicrobial susceptibility and resistance genes of carbapenem-resistant Klebsiella pneumoniae

目的分析某院耐碳青霉烯类肺炎克雷伯菌(CRKP)的药物敏感性及耐药基因携带情况。方法收集2017年1月-2018年6月该院临床分离的CRKP,对菌株进行药物敏感性分析,应用聚合酶链式反应(PCR)检测耐药基因携带情况。结果共收集57株CRKP,主要来源于呼吸道标本,其中痰34株,肺泡灌洗液11株;来源科室主要为神经内科(20株,35.09%)、呼吸内科(15株,26.32%)、重症医学科(9株,15.79%)。CRKP对大部分抗菌药物耐药,部分抗菌药物耐药率相对较低,其中复方磺胺甲口恶唑耐药率最低(15.79%),其次为替加环素(50.88%)、阿米卡星(57.89%)。共检出2种碳青霉烯酶基因(KPC-2、NDM-1),4种超广谱β-内酰胺酶(ESBLs)基因(SHV、CTX-M-9、TEM、CTX-M-1)。57株CRKP均检出ESBLs基因,其中39株(68.42%)检出KPC-2基因,仅有1株检出NDM-1基因。结论临床分离的CRKP耐药形势严峻,并且携带多种耐药基因,其中最常见的产碳青霉烯酶为KPC。

Objective To analyze antimicrobial susceptibility and carrying status of drug resistance genes of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a hospital. Methods CRKP isolated from a hospital between January 2017 and June 2018 were collected, antimicrobial susceptibility of strains was analyzed, polymerase chain reaction (PCR) was used to detect carrying status of drug resistance genes. Results A total of 57 strains of CRKP were collected, mainly from respiratory tract specimens, including sputum ( n =34) and alveolar lavage fluid ( n =11). The main source departments of CRKP were department of neurology ( n =20, 35.09%), department of respiratory medicine ( n =15, 26.32%), and department of critical medicine ( n =9, 15.79%). CRKP was resistant to most antimicrobial agents, but resistance rates to some antimicrobial agents were relatively low, compound sulfamethoxazole had the lowest resistance rate (15.79%), followed by tegacycline (50.88%) and amikacin (57.89%). Two carbapenemase genes (KPC-2, NDM-1) and four extended-spectrum β-lactamases (ESBLs) genes (SHV, CTX-M-9, TEM, CTX-M-1) were detected. 57 strains of CRKP were all detected ESBLs genes, 39 (68.42%) of which were detected KPC-2 gene, and only 1 was detected NDM-1 gene. Conclusion Antimicrobial resistance of clinically isolated CRKP is severe, CRKP carries multiple drug resistance genes, the most common carbapenemase is KPC.