期刊文献+

耐碳青霉烯类肺炎克雷伯菌的临床分布及耐药特征 被引量:6

Clinical distribution and drug resistance characteristics of carbapenem-resistant Klebsiella pneumoniae
原文传递
导出
摘要 探讨耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)的临床分布及耐药特征,为预防CRKP的感染和治疗提供参考依据。回顾性分析2017年1月至2021年12月临床分离的510株CRKP菌株,应用MALDI-TOF质谱仪和VITEK-2 Compact微生物药敏分析仪进行菌种鉴定和药敏试验,采用碳青霉烯酶抑制剂增强试验对CRKP菌株进行碳青霉烯酶表型检测,通过免疫显色法对CRKP菌株进一步分型并用聚合酶链反应(polymerase chain reaction,PCR)进行基因检测。结果显示,510株CRKP菌株主要来源于痰液302株(59.2%)、尿液127株(24.9%)、血液47株(9.2%);科室主要分布于重症医学科231株(45.3%),其次为呼吸内科108株(21.2%)和神经外科79株(15.5%);药敏试验结果显示对常用抗菌药物的耐药率均较高,仅对替加环素和头孢他啶/阿维巴坦保持很好的敏感性,但对替加环素的耐药率逐年上升,从2017年的1.0%上升到2021年的10.1%,差异有统计学意义(χ^(2)=14.444,P<0.05)。碳青霉烯酶抑制剂增强试验结果显示,510株CRKP中产碳青霉烯酶461株(90.4%),其中丝氨酸酶450株(88.2%),金属酶9株(1.8%),既产丝氨酸又产金属酶2株(0.4%);不产酶的有49株(9.6%);免疫显色法进一步分型显示461株CRKP中分型检测为KPC 450株(97.6%),IMP 2株(0.4%);NDM 7株(1.5%);KPC+NDM 2株(0.4%);PCR基因检测结果:blaKPC 450株(97.6%),blaIMP 2株(0.4%),blaNDM 7株(1.5%),blaKPC+NDM 2株(0.4%)。综上,CRKP菌株主要来源于痰液标本,分布于重症医学科,耐药特征以产碳青霉烯酶中的KPC型为主,临床微生物实验室应加强对CRKP菌株的监测,为预防CRKP的感染,减少细菌耐药的产生提供参考依据。 To explore the clinical distribution and drug resistance characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP),in order to provide reference for the prevention and treatment of CRKP infection.Retrospective analysis was performed on 510 clinical isolates of CRKP from January 2017 to December 2021,and strain identification and drug sensitivity tests were conducted by MALDI-TOF mass spectrometer and VITEK-2 Compact microbial drug sensitivity analyzer.The carbapenemase phenotype of CRKP strain was detected by carbapenemase inhibitor enhancement test.The CRKP strain was further categorized by immunochromogenic method and polymerase chain reaction(PCR)was used for gene detection.The results showed that 302 strains(59.2%)were derived from sputum,127 strains(24.9%)from urine and 47 strains(9.2%)from blood.231(45.3%)were mainly distributed in intensive care,followed by 108(21.2%)in respiratory medicine and 79(15.5%)in neurosurgery.Drug susceptibility test result shows that the resistant rate of tigecycline increased from 1.0%in 2017 to 10.1%in 2021,the difference was statistically significant(χ^(2)=14.444,P<0.05).The results of carbapenemase inhibitor enhancement test showed that 461 carbapenemase strains(90.4%)of 510 CRKP strains,including 450 serinase strains(88.2%),9 metalloenzyme strains(1.8%),and 2 strains(0.4%)produced both serine and metalloenzyme.49 strains(9.6%)did not produce enzymes.Further typing by immunochromogenic assay showed that 461 CRKP strains were KPC 450(97.6%)and IMP 2(0.4%).7 NDM(1.5%);2 strains of KPC+NDM(0.4%);PCR results were as follows:450 strains of blaKPC(97.6%),2 strains of blaIMP(0.4%),7 strains of blaNDM(1.5%),and 2 strains of blaKPC+NDM(0.4%).In conclusion,CRKP strains mainly originated from sputum specimens and distributed in intensive care department,and the drug resistance characteristics were mainly KPC type in carbapenemase production.Clinical microbiology laboratory should strengthen the monitoring of CRKP strains,so as to provide reference for preventing CRKP infection and reducing the production of bacterial drug resistance.
作者 沈翠芬 张晓祥 鲍超驰 Shen Cuifen;Zhang Xiaoxiang;Bao Chaochi(Clinical Laboratory,Huzhou Central Hospital,Huzhou 313000,China)
出处 《中华预防医学杂志》 CAS CSCD 北大核心 2023年第3期416-421,共6页 Chinese Journal of Preventive Medicine
基金 湖州市公益性应用研究项目(2019GYB24)。
关键词 肺炎克雷伯菌 耐碳青霉烯类肺炎克雷伯菌 细菌耐药 Klebsiella pneumoniae Carbapenem-resistant Klebsiella pneumoniae Bacterial drug resistance
  • 引文网络
  • 相关文献

参考文献13

二级参考文献72

共引文献300

同被引文献43

引证文献6

二级引证文献2

;
使用帮助 返回顶部