肺移植患者术后感染CR-KPN的分子分型研究

A molecular epidemiological study of carbapenem-resistant Klebsiella pneumoniae infecting patients after lung transplantation

目的对肺移植科患者感染的碳青霉烯类耐药肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae,CR-KPN)进行分子分型和耐药谱分型分析,为制订合理的感染控制方案提供依据。方法用质谱仪和vitek2药敏分析系统对肺移植科分离的48株CR-KPN进行鉴定并分析其耐药表型模式;采用脉冲场凝胶电泳(Pulsed-field gel electrophoresis,PFGE)对CR-KPN菌株做分子分型分析。结果根据CR-KPN对头孢他啶、磷霉素等16种抗生素的药敏结果的不同分组,其中对抗生素药敏结果相同的菌株分为一型,药敏结果不同的分为另一型,48株CR-KPN分为8个型。对48株CR-KPN做PFGE电泳,共得到A-F等6个基因型。结论 CR-KPN耐药谱特征和PFGE分型检测是肺移植术后CR-KPN感染及及其分子分型的重要手段,对治疗性抗生素的选择和调整预防性抗生素治疗有指导作用。

Objectives To perform a molecular epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae(CR-KPN)infecting patients in the Lung Transplantation department at this Hospital and to provide evidence for formulating a rational prevention and treatment plan to control infection with CR-KPN.Methods Forty-eight strains of CR-KPN isolated from patients in the Lung Transplantation department were identified using mass spectrometry and a Vitek2 susceptibility analysis system,and drug resistance phenotypes were analyzed.The molecular epidemiology of CR-KPN strains was analyzed using PFGE.Results Based on differences in the susceptibility of CR-KPN to ceftazidime,fosfomycin,and 16 other antibiotics,strains with the same level of susceptibility to antibiotics were classified as one type;strains with differing levels of susceptibility were classified as another type.Forty-eight strains of CR-KPN were divided into eight types,and the 48 strains of CR-KPN were divided into six PFGE genotypes,A-F.Conclusions The combination of the CR-KPN drug resistance spectrum and PFGE typing technology is a good research tool for outbreaks and the epidemiology of CR-KPN nosocomial infections in patients in the Lung Transplantation department.This approach can guide the selection and adjustment of therapeutic antibiotics and preventive antibiotic therapy.