耐碳青霉烯肺炎克雷伯菌流行病学分析

The epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae

目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药特点、临床分布及毒力因子的携带情况,为临床诊治提供参考依据方法收集临床分离的43株CRKP菌株,MALDI-TOF质谱仪进行菌株鉴定,Vitek-2compact进行药敏试验,黏液丝试验检测高黏液表型,对菌株毒力因子行PCR扩增和基因测序。结果43株CRKP菌株中,痰液、大便检出率最高,其次为血液、无菌体液;科室分布以丨CU为主,其次是血液内科;CRKP对妥布霉素、阿米卡星、替加环素及粘菌素耐药率稍低,分别为81.4%、76.4%、65.1%和11.6%,对其他药物耐药率均>90%。仅检测到1株荚膜血清型阳性菌株,为K5型;uge、wabG、ycf、entB、ureA及fimH毒力基因携带率最高,均>90%,未检出iroB、alls、magA和wcaG基因;毒力基因携带模式以uge+wabG+finiH+rmpA+ycf+ureA+ybtA+iutA+entB+rmpA2+iucA+peg-344为主,占44.2%;菌株Hcp、Ompk35和Ompk36基因携带率高,均>90%,结论CRKP多为广泛耐药菌株,大多携带多种毒力因子,且患者预后不佳,需引起临床重视,加强CRJCP菌株防控,合理选用抗生素。

Objective To analyze the drug-resistant phenotype,clinical dsribution and the virulence factors of carbapenem-reistant Klebsiella Pneumoniae(CRKP),so as to provide reference for dinical diagnosis and treatment.Methods The 43 strains of CR KP isolated from clinical practice were collected.The strains were identified by MALDI-TOF,and antimic robial susceptibility testing was carried out by Vitek-2 compact.The HM phenotype of CR KP was determined by string test.The vinulence factors were analyzed by PCR and sequence alignment.Results Among the 43 strains of CRKP,the source of specimens were mainly sputum and stool,fllowed by blood and sterile body fluids.The department was mainly disributed in the ICU,ollwed by hematology.More than 90%of the strains were resistant to other antibiotics tested except tobramycin(81.4%),amikacin(76.4%),tegacycline(65.1%)and colistin(11.6%)in the 43 strains.1 strain was positive for amplification of K5 capsule genotype in the 43 strains.The detection rates of fimH,uge.wabG,ycf,entB and ureA were higher in virulence genes,all above 90%;iroB,als,magA and waG genes were not detected.The virulence gene carrying mode was mainly uge+wabG+fimH+rmpA+yef+ureA+ybtA+iutA+entB+rmpA2+iucA+peg-344,accounting for 44.2%,Hcp,Ompk35 and Ompk36 genes were highly carried by the stains,all above 90%.Conclusion The strins of CRKP are extensive-drug-resistance,and most of strains carry a variety of virulence genes.In addition,the prognosis of the patients is poor,and it is necessary for clinical workers to strengthen prevention and control of these strains and rational use of antibiotics.