综合重症监护病房分离的耐碳青霉烯类肺炎克雷伯菌耐药性和同源性分析

Drug resistance and homology analysis of carbapenem-resistant Klebsiella pneumoniae isolated from intensive care unit

目的对综合重症监护病房分离的耐碳青霉烯类肺炎克雷伯菌(CRKP)耐药性和同源性进行分析,为临床抗菌治疗和监测提供参考。方法收集2019年3月至2021年3月2家医院综合重症监护病房分离得到的260株CRKP菌(其中马鞍山某医院156株,苏州某医院104株),并对CRKP菌株进行常规药敏试验、PCR扩增和测序检测耐药基因携带情况,利用脉冲场凝胶电泳(PFGE)技术和多位点序列分型技术(MLST)对CRKP菌株进行同源性分析。结果260株CRKP菌株对17种临床常用抗菌药物高度耐药,多重耐药率100%。马鞍山某医院的CRKP菌株主要携带碳青霉烯酶及超广谱β内酰胺酶(ESBLs)基因共5种耐药基因,bla^(KPC-2)型、bla^(NDM-1)型、bla^(SHV)型、bla^(TEM)型和bla^(CTX-M-1)型的携带率分别为84.62%、3.21%、70.51%、71.79%和80.77%。苏州某医院的CRKP菌株共携带bla^(KPC-2)型、bla^(NDM-1)型、bla^(SHV)型、bla^(TEM)型和bla^(CTX-M-9)型共5种耐药基因,携带率分别为74.04%、23.08%、80.77%、76.92%和27.88%。PFGE分型结果显示2家医院CRKP菌株均以A型和C型为主,但亚型和数量有差异。MLST分型分出ST11、ST76、ST16、ST437、ST379、ST751、ST395和ST307共8种序列型,马鞍山某医院主要为ST11型,占83.97%,而苏州某医院以ST11型(65.38%)和ST76型(27.88%)为主。结论2家医院综合重症监护病房的CRKP菌株存在一定差别,但均以携带KPC-2碳青霉烯酶基因的ST11型为主,针对性加强重症监护病房清洁和院感监测,有利于控制多重耐药菌的传播和流行。

Objective To investigate and analyze the drug resistance and homology of carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated from intensive care unit(ICU)in order to provide reference for clinical antimicrobial treatment and monitoring.Methods From March 2019 to March 2021,260 strains of CRKP(including 156 strains from a hospital in Ma'anshan and 104 strains from a hospital in Soochow)were isolated from the ICUs of two hospitals.Routine drug sensitivity test,PCR amplification and sequencing were used to detect the drug resistance genes,homology analysis of CRKP strains was carried out by pulsed field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).Results All 260 strains of CRKP were highly resistant to 17 kinds of commonly used antibiotics,and the multiple drug resistance rate was 100%.CRKP strains isolated from the hospital in Ma'anshan mainly carried carbapenemase and extended spectrumβ-Lactamases(ESBLs)gene,including five kinds of drug resistance genes.The carrying rates of bla^(KPC-2),bla^(NDM-1),bla^(SHV),bla^(TEM) and bla^(CTX-M-1) were 84.62%,3.21%,70.51%,71.79%and 80.77%respectively.CRKP strains isolated from the hospital in Soochow carried five kinds of drug resistance genes,namely bla^(KPC-2),bla^(NDM-1),bla^(SHV),bla^(TEM) and bla^(CTX-M-9),the carrying rates were 74.04%,23.08%,80.77%,76.92%and 27.88%respectively.PFGE typing results showed that both of CRKP strains in the two hospitals were mainly type A and type C,but the subtypes and quantity were different.According to MLST classification,8 sequence types were identified,including ST11,ST76,ST16,ST437,ST379,ST751,ST395 and ST307.The main sequence type was ST11 in the hospital in Ma'anshan,accounting for 83.97%.While the hospital in Soochow was mainly ST11(65.38%)and ST76(27.88%).Conclusion There are some differences in CRKP strains in the ICUs of two hospitals,but they are both mainly ST11 type carrying KPC-2 carbapenemase gene.Strengthening ICU cleaning and nosocomial infection monitoring is conducive to controlling the spread and prevalence of multi drug resistant bacteria.