肺炎克雷伯菌对头孢他啶/阿维巴坦的耐药性分析

Analysis of the resistance of Klebsiella pneumoniae to ceftazidime/avibactam

目的探讨肺炎克雷伯菌对头孢他啶/阿维巴坦的耐药性。方法选取2018年1月至2020年6月该院检出的1785株肺炎克雷伯菌为研究对象,对其进行药敏试验。采用改良碳青霉烯类灭活法(mCIM)和乙二胺四乙酸碳青霉烯类灭活法(eCIM)检测耐碳青霉烯类肺炎克雷伯菌(CRKP)的碳青霉烯酶和金属β-内酰胺酶;采用碳青霉烯酶抑制增强试验检测CRKP的丝氨酸酶和金属β-内酰胺酶。对19株CRKP进行碳青霉烯酶耐药基因检测。结果1785株肺炎克雷伯菌对头孢他啶/阿维巴坦的敏感率为95.49%,121株CRKP对头孢他啶/阿维巴坦的敏感率为80.17%。101株CRKP mCIM阳性(83.5%),其中22株eCIM阳性(21.8%);碳青霉烯酶抑制增强试验检测出78株产丝氨酸酶,22株产金属β-内酰胺酶,1株同时产丝氨酸酶和金属β-内酰胺酶。19株进行碳青霉烯酶耐药基因检测的CRKP中,15株检测出blaKPC-2,3株检测出blaNDM-1,1株同时检测出blaNDM-1和blaKPC-2。结论头孢他啶/阿维巴坦是治疗临床肺炎克雷伯菌感染,尤其是CRKP感染的有效药物,碳青霉烯酶耐药基因鉴定具有临床指导意义。

Objective To investigate the resistance of Klebsiella pneumoniae to ceftazidime/avibactam.Methods Selected 1785 Klebsiella pneumoniae strains detected in this hospital from January 2018 to June 2020 as the research objects,carried out drug sensitivity test.The modified carbapenem inactivation method(mCIM)and the ethylenediaminetetraacetic acid carbapenem inactivation method(eCIM)were used to detect carbapenemase and metalβ-lactamase,carbapenemase inhibition enhancement test was used to detect serinase and metalβ-lactamase of carbapenem-resistant Klebsiella pneumoniae(CRKP).Carried out carbapenemase resistance gene detection in 19 CRKP strains.Results The sensitivity rate of 1785 Klebsiella pneumoniae strains to ceftazidime/avibactam was 95.49%,and the sensitivity rate of 121 CRKP strains to ceftazidime/avibactam was 80.17%.A total of 101 CRKP strains were positive for mCIM(83.5%),of which 22 strains were positive for eCIM(21.8%).The carbapenemase inhibition enhancement test detected 78 strains producing serinase,22 strains producing metalβ-lactamase,and 1 strain producing both serinase and metalβ-lactamase.A total of 19 CRKP strains were detected the carbapenemase resistance genes,of which 15 strains detected blaKPC-2,3 strains detected blaNDM-1,and 1 strain detected both blaNDM-1 and blaKPC-2.Conclusion Ceftazidime/avibactam is an effective drug for the treatment of clinical Klebsiella pneumoniae infections,especially CRKP infections,and the identification of carbapenemase resistance genes has clinical guiding significance.