碳青霉烯类耐药肺炎克雷伯菌基因型检测研究

Genotype detection of carbapenem-resistant Klebsiella pneumoniae

目的 分析碳青霉烯类耐药肺炎克雷伯菌(CRKP)不同基因型耐药性及临床特征差异,为临床预防及治疗CRKP感染提供参考。方法 回顾性分析我院2018年9月—2021年8月收治的56例分离出CRKP菌株患者的临床资料,检测其耐药基因,并分析不同基因型CRKP的耐药性和临床特征。结果 56株CRKP中检出47株KPC型耐药基因(83.93%)、9株NDM-1型耐药基因(16.07%),未检出IMP、VIM以及OXA-48耐药基因;耐药性分析结果发现,KPC和NMD-1型耐药基因对氨曲南耐药性差异有统计学意义(P<0.05);KPC和NMD-1型耐药基因对应患者年龄、性别、收治科室、标本来源分布情况、合并基础疾病、抗菌药物使用时间、3种及以上抗菌药物联用史、住院时间以及侵入性操作比较差异均无统计学意义(P>0.05)。结论 CRKP基因型主要以KPC型最常见,不同基因型CRKP临床特征无明显差异,不同基因型CRKP对常用抗菌药物耐药性存在异质性,临床抗感染治疗需结合基因检测及耐药性分析制定合理方案。

Objective To analyze the drug resistance and clinical characteristics of different genotypes of carbapenem-resistant Klebsiella pneumoniae(CRKP), and to provide a reference for clinical prevention and treatment of CRKP infection. Methods The clinical data of 56 patients with isolated CRKP strains admitted to our hospital from September 2018 to August 2021 were retrospectively analyzed. The drug resistance and clinical characteristics of different genotypes of CRKP were analyzed. Results Among 56 CRKP strains, 47(83.93%) strains with the KPC gene and 9(16.07%) strains with the NDM-1 gene were detected, but no IMP, VIM, or OXA-48 was detected. The results of drug resistance analysis showed that the resistance of KPC and NMD-1 to aztreonam was significantly different(P<0.05). There was no significant difference in age, gender, department, specimen source, underlying diseases, time of using antibiotics, history of combined use of 3 or more antibiotics, length of hospital stay, and invasive procedures between patients carrying KPC and NMD-1(P>0.05). Conclusion KPC type is the most common genotype of CRKP. There is no significant difference in the clinical characteristics of different genotypes of CRKP, and the resistance of different genotypes of CRKP to commonly used antibiotics is heterogeneous. Clinical anti-infection treatment should be combined with genetic testing and drug resistance analysis to develop a reasonable plan.