龙岩市肺炎克雷伯菌分子分型与耐药性分析

Analysis of molecular typing and drug resistance of Klebsiella pneumoniae in Longyan City

目的了解龙岩地区人感染肺炎克雷伯菌的分子分型特征、耐药特性及部分耐药机制,为肺炎克雷伯菌感染的防治提供参考。方法收集2017-2020年龙岩市辖区综合医院分离的人感染肺炎克雷伯菌,采用PFGE技术进行分子分型检测,运用BioNumerics软件进行聚类分析,采用MIC法及K-B法进行耐药性检测。结果66.67%的肺炎克雷伯菌分离自痰液标本,129株肺炎克雷伯菌分子分型与聚类分析显示龙岩市人感染肺炎克雷伯菌菌株间相似度为54.3%~100%,可分为118个PFGE型别,不存在优势流行型别。对110株肺炎克雷伯菌进行药敏试验,有92株耐药,耐药率为0.90%~22.73%,其中产AmpC酶菌3株,占3.26%(3/92),该菌对左氧氟沙星敏感;产ESBLs酶菌株占21.82%(24/110),对多粘菌素B和亚胺培南均敏感。产AmpC或ESBLs菌株对抗菌药物的耐药率显著高于不产AmpC和ESBLs的菌株(χ^(2)AmpC=60.682,P<0.01;χ^(2)ESBLs=122.038,P<0.01)。3株菌对美罗培南耐药,其中1株同时对亚胺培南耐药,1株同时对多粘菌素耐药。多重耐药肺炎克雷伯菌检出率为15.45%,最多达八重耐药。结论龙岩市人感染肺炎克雷伯菌呈分子多态性分布,对抗菌药物总体耐药相对较低,产AmpC酶较低,但产ESBLs酶及多重耐药率较高,存在产碳青酶烯酶且同时耐多粘菌素的强耐药株,因此需要加强对肺炎克雷伯菌的耐药性监测。

Objective To understand the molecular typing characteristics,drug resistance characteristics and partial drug resistance mechanism of Klebsiella pneumoniae isolated from patientsin Longyan City,so as to provide reference for the prevention and treatment of K.pneumoniae infection.Methods K.pneumoniae isolated from the general Hospital of Longyan Cityfrom 2017 to 2020 were collected,PFGE technology was used for molecular typing detection,BioNumerics software was used for cluster analysis,and MIC and K-B methods were used for drug resistance detection.Results 66.67%of K.pneumoniae were isolated from sputum samples.Molecular typing and cluster analysis of 129 strains of K.pneumoniae in Longyan City showed that the similarity among the strains was 54.3%-100%,which could be divided into 118 PFGE types,and there was no dominant epidemic type.The drug susceptibility test of 110 strains of K.pneumoniae showed that 92 strains were resistant to drugs,with resistance rates ranging from 0.90%to 22.73%.Among them,3 strains producing AmpCβ-lactamases accounted for 3.26%(3 of 92),which were sensitive to levofloxacin.ESBLs-producing strains accounted for 21.82%(24/110),and were sensitive to both polymyxin B and imipenem.The antimicrobial resistance rate of strains AmpC or ESBLs producing strains was significantly higher than that of strains non-AmpC or non-ESBLs producing(χ^(2)_(AmpC)=60.682,P<0.01;χ^(2)_(ESBLs)=122.038,P<0.01).Three strains were resistant to meropenem,among which 1 strain was resistant to imipenem and 1 strain was resistant to polymyxin.The detection rate of multidrug-resistant K.pneumoniae was 15.45%,with up to eight multidrug-resistant bacteria.Conclusion K.pneumoniae isolated from Longyan Cityshowed molecular polymorphism distribution,and overall resistance to antibiotics was relatively low,low production of AmpCβ-lactamases,but high production of ESBLsβ-lactamases and multi-drug resistance,there were carbapenase production and polymyxin resistant strains,it is necessary to strengthen the resistance surveillance of K.pneumoniae.