三亚某三甲医院耐碳青霉烯类肺炎克雷伯菌耐药性及分子流行病学特征

Surveillance of drug resistance and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae in a grade A tertiary hospital of Sanya

目的了解三亚某医院7年间肺炎克雷伯菌(KP)及耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药性变迁及分子流行病学特征。方法收集2016-2022年三亚中心医院(海南省第三人民医院)分离的KP及CRKP菌株药敏试验结果,通过多位点序列分型(MLST)分析及检测碳青霉烯类耐药基因型等分子特征,并分析流行菌株特征。结果2016-2022年共分离KP3994株,神经外科检出率最高(14.65%),主要分离自痰液(76.56%),对阿米卡星和替加环素耐药率较低,对头孢类药物耐药率高;7年间对常用抗菌药物耐药率呈下降趋势(P<0.05);2016-2022年共分离CRKP45株,儿科检出率最高(28.89%),主要来自痰液(60.00%);对酶抑制剂药物耐药率均>88.00%,对头孢类药物高度耐药,耐药率均>93.00%;替加环素耐药率较低;碳青霉烯酶基因检测结果为NDM型、KPC型、IMP型、VIM型,同时携带有2种基因型;儿科分离的CRKP以KPC型为主,占23.08%;MLST分型共获得26种ST型,以ST571(20.00%)为优势型别,是主要流行株,在本地社区流行传播具有密切亲缘关系。结论2016-2022年该医院分离的KP对常用抗菌药物耐药率呈下降趋势。CRKP对常用抗菌药物高度耐药,主要携带NDM型碳青霉烯酶为主要耐药机制;菌株分子分型动态性多样,存在优势克隆ST571型CRKP在医院流行和传播,需加强医院感染防控。

OBJECTIVE To investigate the changes of drug resistance and molecular epidemiological characteristics of Klebsiella pneumoniae(KP)and carbapenem-resistant Klebsiella pneumoniae(CRKP)in a grade A tertiary hospital in Sanya during the past seven years.METHODS The results of drug susceptibility of KP and CRKP strains isolated from Sanya Central Hospital(the Third People's Hospital of Hainan Province)during 2016 and 2022 were collected.Molecular characteristics such as drug-resistant genotypes of carbapenems were analyzed and detected by multilocus sequence typing(MLST).And the characteristics of epidemic strains were analyzed.RESULTS A total of 3994 strains of KP were isolated from 2016 to 2022.The detection rate in the neurosurgery department was the highest(14.65%),which was mainly isolated from sputum(76.56%).The drug resistance rate to amikacin and tigacycline was low,and the drug resistance rate to cephalosporin was high.The drug resist-ance rate to common antibiotics showed a decreasing trend in seven years(P<0.05).A total of 45 strains of CRKP were isolated between 2016 and 2022,and the detection rate was the highest in the paediatrics department(28.88%),mainly from sputum(60.00%).The drug-resistant rate to enzyme inhibitors was>88.00%,and the drug-resistant rate to cephalosporins was>93.00%.The drug-resistant rate to tigacycline was low.The geno-types of carbapenemase gene detected were NDM,KPC,IMP and VIM,and patinets carrying two genotypes at the same time.The main type of CRKP isolated in the paediatrics department were KPC,accounting for 23.08%.A total of 26 ST types were obtained by MLST classification,and ST571(20.00%)was the dominant type,which was the main epidemic strain and closely related to the epidemic in community.CONCLUSION From 2016 to 2022,the drug-resistant rate of KP isolated from this hospital to commonly used antibiotics decreases.CRKP is highly drug-resistant to common antibiotics,and mainly carries NDM carbapenemase as the main drrug resistance mecha-nism.The molecular typing of strains are dynamic and diverse,and the dominant ST571 CRKP clone is prevalent and spreads in hospitals.Prevention and control of nosocomial infection should be strengthened.