ICU病区耐碳青霉烯类肺炎克雷伯菌的耐药及同源性特点分析
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河南省医学科技攻关计划项目(2018020279)


Homology and susceptibility of carbapenem⁃resistant Klebsiella pneumonia in Intensive Care Unit
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    摘要:

    目的:分析ICU病房耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)的耐药状况和同源性。方法:收集河南科技大学第一附属医院2018年3—9月肺炎克雷伯菌临床分离株171株。基质辅助激光解析电离飞行时间质谱(MALDI-TOF MS)进行菌株鉴定,琼脂稀释和微量肉汤稀释法检测药物最小抑菌浓度(minimum inhibitory concentration,MIC)值,多位点序列分型(MLST)进行同源性测定,mCIM和eCIM实验进行碳青霉烯酶初筛,β-内酰胺酶、血清荚膜分型基因进行PCR扩增后测序。结果:全院共检出CRKP 68株(39.8%,68/171),其中ICU病区46株(67.6%,46/68)。46株CRKP对头孢他啶阿维巴坦、替加环素、多黏菌素、米诺环素的耐药率分别为0、0、4.3%、41.7%;菌株在美罗培南、亚胺培南、头孢他啶、氯霉素、磷霉素、氨曲南、环丙沙星MIC90>128;93.5%(43/46)CRKP为ST11型;60.9%(28/46)荚膜血清分型为K47,23.9%(11/46)为K64;46(100%)株均携带blaKPC-2、blaSHV和blaTEM,40株(86.96%)携带blaCTX-M,6株(13.04%)携带blaDHA。结论:该院流行于ICU病区的CRKP菌株以ST11型为主,大多数菌株同时携带blaKPC-2、blaSHV、blaTEM和blaCTX-M。细菌耐药程度高,感染控制部门应重视ICU病区的CRKP传播问题。

    Abstract:

    Objective:This study aims to analyze susceptibility and homology of clinically isolated carbapenem-resistant Klebsiella pneumoniae(CRKP)from ICU ward. Methods:A total of 171 independent CRKP isolates were collected between March 2018 and September 2018 from the First Affiliated Hospital of Henan University of Science and Technology. The isolates were identified by MALDI-TOF MS,characterized by agar dilution,microdilution methods and multilocus sequence typing(MLST). Carbapenemase phenotype was confirmed by mCIM and eCIM test. β-lactamases and serotype were detected by polymerase chain reaction and DNA sequencing. Results:There were 68(39.8%,68/171)CRKP isolates in the hospital and 46(67.6%,46/68)isolates of CRKP in ICU. The resistant rate of the 46 isolates to ceftazidime/avibactam,tigecycline,colistin,and minocycline were 0,0,4.3%,and 41.7%. MIC90 of meropenem,imipenem,ceftazidime,chloramphenicol,fosfomycin,and aztreonam were over 128. Sequence type(ST)11(43/46,93.5%)were predominant. K47(60.9%,28/46)was the most common serotype,followed by K64(23.9%,11/46). The isolates all harbored β-lactamases of blaKPC-2,blaSHV,and blaTEM,and harbored blaCTX-M (40/46,86.96%),blaDHA(6/46,13.04%). Conclusion:Most CRKP in ICU are ST11,which co-carried blaKPC-2,blaSHV,blaTEM,and blaCTX-M. All isolates showed serious antimicrobial resistance. Nosocomial infection control may be should focus on preventing CRKP transfer in ICU.

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王媛媛,胡红霞,梁建红,简雪峰,王 启. ICU病区耐碳青霉烯类肺炎克雷伯菌的耐药及同源性特点分析[J].南京医科大学学报(自然科学版),2020,(10):1529-1533

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  • 收稿日期:2020-03-07
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  • 在线发布日期: 2020-11-10
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