耐碳青霉烯肺炎克雷伯菌分子流行病学分析

Molecular epidemiological analysis of carbapenem resistant Klebsiella pneumoniae

目的分析温州医科大学附属第三医院2013年-2016年耐碳青酶烯肺炎克雷伯菌的药敏特点、耐药基因携带情况和同源性关系,明确近4年耐药菌的流行情况和变化趋势,为医院感染管理及该菌株暴发流行的预防和控制提供流行病学证据。方法收集温州医科大学附属第三医院2013年1月-2016年12月49株目的菌进行鉴定及药敏试验,检测菌株的KPC酶耐药基因,利用脉冲场凝胶电泳分析其同源性。结果鉴定的49株菌为肺炎克雷伯菌其对阿米卡星的耐药率为77.6%,对亚胺培南、美罗培南全耐药,对多黏菌素100%敏感,替加环素敏感率为63.3%,对阿米卡星耐药率为89.0%。脉冲场凝胶电泳对KPN进行同源性分析可将其划分为9种脉冲带型。结论温州医科大学附属第三医院耐碳青酶烯肺炎克雷伯菌呈克隆传播,产KPC酶肺炎克雷伯菌对多黏菌素和替加环素较为敏感,可作为临床用药参考。

Objective To analyze drug sensitivity,resistance genes and homology of carbapenem resistant Klebsiella pneumoniae separated in the Third Affiliated Hospital of Wenzhou Medical University from 2013 to 2016.To investigate the epidemics and trends of the carbapenem resistant Klebsiella pneumoniae in nearly four years,so as to provide epidemiological basis for the prevention and control of epidemic outbreaks and help for the management of hospital infection.Methods Forty nine strains of carbapenem resistant Klebsiella pneumoniae were collected from January 2013 to December 2016 in the Third Affiliated Hospital of Wenzhou Medical University for identification.The KPC enzyme resistance gene of the strain was detected,and the homology of the 49 strains of Klebsiella pneumoniae was analyzed by pulsed-field gel electrophoresis.Results The identified 49 strains of Klebsiella pneumoniae were 77.6%resistant to amikacin,fully resistant to imipenem and meropenem,100%sensitive to polymyxin,tigecycline.The sensitivity rate was 63.3%,and the resistance rate to amikacin was 89.0%.The homology analysis of KPN by pulse length gel electrophoresis can be divided into 9 pulse band types.Conclusion The homology analysis of the carbapenem resistant Klebsiella pneumoniae showed clonal spread in the Third Affiliated Hospital of Wenzhou Medical University,the management of hospital infection should be strengthened.The strains of Klebsiella pneumoniae with KPC gene were sensitive to tigecycline and polymyxin,these drugs can be used for clinical treatment.