耐碳青霉烯肺炎克雷伯菌耐药基因检测及同源性分析

Resistance mechanisms and homology analysis in carbapenem-resistant Klebsiella pneumoniae

目的了解耐碳青霉烯肺炎克雷伯菌(CRKP)耐药基因及同源性分析。方法收集2020年1月~2022年12月我院临床分离的耐碳青霉烯肺炎克雷伯菌,VITEK 2 Compact全自动细菌鉴定分析仪进行细菌鉴定及药敏检测,聚合酶链反应(PCR)检测CRKP常见的耐药基因,多位点序列分析(MLST)进行同源性分析。结果21株CRKP对妥布霉素的耐药率为57.1%,对环丙沙星的耐药率为71.4%,对氨曲南的耐药率为76.2%,对头孢类和氨基糖苷类耐药率均超过90%.耐药基因检测结果:13株检出bla KPC基因,11株检出bla VIM基因,10株检出bla NDM基因,5株检出OXA-48基因,未检出IMP基因。MLST分型结果为11株为ST11型,5株ST45型,ST307,ST281,ST893,ST101和ST2059各1株。结论CRKP对常用抗生素呈现较高的耐药率,bla KPC耐药基因检出率最高,MLST分型以ST11型为主,故应加强多重耐药菌的监控,控制其传播流行。

Objective To understand the drug resistance gene and homology analysis of carbapenemase-resistant Klebsiella pneumoniae(CRKP).Methods CRKP isolated from our hospital from January 2020 to December 2022 were collected.VITEK 2 Compact automatic bacterial identification analyzer was used for bacterial identification and drug sensitivity detection.PCR was used to detect common CRKP drug resistance genes,and multilocus sequence analysis(MLST)was performed for homology analysis.Results The drug resistance rates of 21 strains of CRKP to,tobramycin,ciprofloxacin,amtrionam and cephalosporin were 57.1%,71.4%,76.2%,and more than 90%,respectively.Drug resistance gene detection results:blA KPC gene was detected in 13 strains,bla VIM gene was detected in 11 strains,bla NDM gene was detected in 10 strains,OXA-48 gene was detected in 5 strains,and IMP gene was not detected.MLST typing results showed that 11 strains were ST11 type,5 strains were ST45 type,and 1 strain was ST307,ST281,ST893,ST101 and ST2059 respectively.Conclusion CRKP has a high drug resistance rate to commonly used antibiotics,and the detection rate of BLA KPC drug resistance gene is the highest.MLST type is mainly ST11.Therefore,monitoring of multiple drug resistance bacteria should be strengthened to control its spread.