耐碳青霉烯类的肺炎克雷伯菌的感染特点及耐药基因分析

Infection characteristics and resistant gene of carbapenem-resistant Klebsiella pneumoniae

目的了解该院耐碳青霉烯类肺炎克雷伯菌的感染特点、药物敏感性和碳青霉烯酶基因携带情况。方法收集该院2018年1月至2019年2月临床标本中分离的非重复耐碳青霉烯类的肺炎克雷伯菌,采用VITEK 2 Compact全自动微生物鉴定仪进行细菌鉴定及药敏检测,改良碳青霉烯灭活试验(mCIM)和EDTA改良碳青霉烯灭活试验(eCIM)检测碳青霉烯酶表型、聚合酶链反应(PCR)检测碳青霉烯酶常见基因型。结果共收集95株耐碳青霉烯类肺炎克雷伯菌,细菌对多种临床常用抗菌药物均显著耐药。改良碳青霉烯灭活试验(mCIM)91株阳性,EDTA改良碳青霉烯灭活试验(eCIM)3株阳性。PCR结果显示92株携带碳青霉烯酶基因,未检测出耐药基因有3株,其中有86株携带KPC基因(93.4%),3株携带NDM基因,3株既携带KPC基因又携带NDM基因。结论耐碳青霉烯类的肺炎克雷伯菌对多种抗菌药物耐药,对四环素、多西环素、替加环素相对敏感,而产KPC型碳青霉烯酶是该院肺炎克雷伯菌碳青霉烯类抗菌药物耐药的主要原因。因此临床应根据药物敏感性结果合理选用抗菌药物,做好院感监测及防护,以防止耐药菌株的传播和流行。

Objective To investigate the characteristics and drug sensitivity of carbapenem-resistance Enterobacteriaceae(CRE)infection in our hospital,and study the genotypic analysis of carbapenemase genes.Methods 95 isolates of CRKPs were isolated from clinical specimens from January 2018 to February 2019 in our hospital.Bacterial identification and antimicrobial susceptibility testing were carried out with VITEK 2 Compact automatic microbiological assay system.The detection of carbapenemase-producing Klebsiella pneumoniae was confirmed by modified carbapenem inactivation method(mCIM)and EDTA-modified carbapenem inactivation method(eCIM).Screening of carbapenemase-encoding gene by PCR.Results The 95 isolates showed high-level resistance to the antibiotics commonly used by Clinician.91strains were all positive for mCIM,3 strains were positive for eCIM.Carbapenemase-encoding gene was identified in 92 isolates of Klebsiella pneumoniae,3 strains were not detected having resistance gene.Among which 86 were confirmed as KPC and 3 were NDM.And 3 strains carried both KPC and NDM.Conclusion CRKP showed high resistance to most of the common antimicrobial agents in our hospital,relatively sensitive to tetracycline,doxycycline and tigecycline,KPC carbapenemase was the primary mechanism to cause the bacterial resistance to carbapenems.According to susceptibility test,the hospital should enhance the drug-resistance surveillance and use antibiotics reasonable to control the multi-drug resistance and the prevalence of resistant strains.