耐碳青霉烯类肺炎克雷伯菌的耐药性分析及分子分型

Drug resistance analysis and molecular typing of carbapenem-resistant Klebsiella pneumoniae

目的分析耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药性及分子分型。方法选取我院2021年3月—2022年3月临床分离的CRKP菌株,进行碳青霉烯酶表型鉴定、药物敏感性试验、耐药基因检测及多位点序列分型(MLST)。结果70株CRKP主要来自痰液、血液和引流液。改良Hodge试验显示63株为阳性,改良碳青霉烯灭活试验显示66例为阳性。CRKP对大多数常规抗菌药物耐药率为90%以上,对替加环素最敏感,耐药率为4.3%。70株CRKP中携带bla_(KPC-2)基因为64株,携带bla_(NDM)基因为8株。MLST可分为6个ST型,其中ST11型为56株,占比最高(80%)。结论临床分离的CRKP MLST仍以ST11型为主,对碳青霉烯类抗菌药物的主要耐药机制为产KPC-2酶,可选择替加环素治疗CRKP感染,但仍要规范使用抗菌药物,防止耐药性进一步产生。

Objective To analyze the drug resistance and molecular typing of carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods The clinically isolated CRKP strains in our hospital from March 2021 to March 2022 were selected to conduct the carbapenem enzyme phenotype identification,drug sensitivity test,resistance gene detection and multilocus sequence typing(MLST).Results The 70 strains of CRKP were mainly from sputum,blood and drainage fluid.The modified Hodge test showed 63 positive strains,and the modified carbapenem inactivation method showed 66 positive cases.CRKP had a resistance rate of over 90%to most conventional antibiotics,and was most sensitive to tigecycline,with a resistance rate of 4.3%.Among the 70 strains of CRKP,64 strains were positive for bla_(KPC-2) and 8 positive for bla_(NDM).These CRKP could be divided into 6 ST types,of which 56 strains were ST11,accounting for the highest proportion(80%).Conclusion MLST of clinically isolated CRKP is still mainly ST11 type,and the main mechanism of resistance to carbapenem antibiotics is the production of KPC-2 enzyme.Tigecycline can be used to treat CRKP infection,but it is still necessary to standardize the use of antibiotics to prevent further development of drug resistance.