ICU患者肠道定植产碳青霉烯酶肺炎克雷伯菌的耐药基因及同源性分析

Drug resistance genes and homological analysis of carbapenem-resistant Klebsiella pneumoniae in intestinal colonization of ICU patients

目的研究ICU患者肠道定植耐碳青霉烯酶肺炎克雷伯菌(CRKP)的临床资料,分析临床特征及分子特点。方法收集衢州市人民医院2021年1月—2022年6月ICU患者肠道定植CRKP,检测5种耐药基因(KPC、NDM、IMP、VIM、OXA-48),采用多位点序列分型(MLST)方法进行分型,采用纸片扩散法(K-B法)和微量肉汤稀释法进行药敏试验。结果41株肠道定植CRKP中ST11型占73.2%(30/41),是主要流行克隆株。菌株几乎对所有β-内酰胺酶类和喹诺酮类抗菌药物耐药,部分菌株对氨基糖苷类敏感,对替加环素依然保持较高敏感率,有4株替加环素中介。耐药基因携带率分别是KPC型占78.0%,NDM型占2.4%,同时携带KPC+NDM型占17.1%,未检测到IMP、VIM、OXA-48阳性菌株。结论ICU患者肠道定植CRKP菌株主要耐药基因是KPC型;主要克隆型是ST11,其检出率及传播风险高,需加强检测和院感防控,防止耐药菌播散。

Objective This paper aims to study the clinical data of carbapenem-resistant Klebsiella pneumoniae(CRKP)colonized in intestinal tract of intensive care unit(ICU)patients and analyze the clinical and molecular characteristics.Methods Intestinal CRKP was collected from the ICU patients in Quzhou People's Hospital from January 2021to June 2022 for the detection of five drug-resistant genes(KPC,NDM,IMP,VIM,OXA-48).Multi-locus sequence typing(MLST)method was used for typing.Disk diffusion method(K-B method)and microbroth dilution method were used for drug sensitivity test.Results ST11,as the main endemic clone,accounted for 73.2%(30/41)of the 41 intestinal colonized CRKP strains.The strains were resistant to almost allβ-lactamases and quinolones.Some strains were sensitive to aminoglycosides,but remained sensitive to tigecycline,and there were 4 tigecycline intermediates.The carrying rates of drug-resistant gene were 78.0%for KPC,2.4%for NDM,and 17.1%for KPC+NDM.No IMP,VIM or OXA-48 strains was detected.Conclusion The main drug resistance gene of intestinal colonized CRKP strain of ICU patients is KPC.The main clone type is ST11,whose detection rate and transmission risk are high.Therefore,it is necessary to strengthen detection and prevention on nosocomial infection to prevent the spread of drug-resistant bacteria.