耐亚胺培南肺炎克雷伯菌的耐药机制研究

发布时间：2018-01-09 23:24

本文关键词：耐亚胺培南肺炎克雷伯菌的耐药机制研究　出处：《中华医院感染学杂志》2016年13期 　论文类型：期刊论文

【摘要】：目的探讨耐亚胺培南肺炎克雷伯菌的流行病学特征和β-内酰胺酶基因型,为临床合理用药和感染控制提供依据。方法收集2014年2-11月临床分离25株耐亚胺培南肺炎克雷伯菌,采用VITEK-2微生物系统检测菌株的药物敏感性;改良Hodge试验检测碳青霉烯酶;PCR检测β-内酰胺酶基因KPC-2、SHV、CTX-M、IMP、VIM、NDM-1、OXA-48;采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC-PCR)对菌株进行同源性分析。结果在检测的18种药物中,哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢唑林、头孢曲松、氨苄西林、厄他培南、亚胺培南、氨曲南的耐药率均为100.0%,磺胺甲VA唑/甲氧苄啶的耐药率最低为32.0%,其次为阿米卡星和妥布要素均为(68.0%);改良Hodge试验阳性20株(80.0%);25株菌均检测到SHV基因,20株菌检测到CTX-M基因,15株检测到KPC-2基因,1株菌检测到IMP-4基因,3株菌检测到NDM-1基因,未检测到VIM、OXA-48基因;25株菌分为6型,为A、B、C、D、E、F,分别有15、5、2、1、1、1株。结论耐亚胺培南的肺炎克雷伯菌多药耐药严重,产生β-内酰胺酶是菌株对多种药物耐药的主要机制,且菌株存在克隆性传播,3株菌检测到NDM-1基因,应引起相关部门的重视。
[Abstract]:Objective to investigate the epidemiological characteristics and 尾 -lactamase genotypes of imipenem-resistant Klebsiella pneumoniae. Methods 25 strains of Klebsiella pneumoniae resistant to imipenem were collected from 2014 to November. VITEK-2 microorganism system was used to detect the drug sensitivity of the strain. Improved Hodge test was used to detect carbapenem. 尾 -lactamase gene (KPC-2) was detected by PCR. The homology of the strains was analyzed by ERIC-PCR. Results among the 18 drugs tested, piperacillin / tazobactam was used. The drug resistance rates of ampicillin / sulbactam, cefazolin, ceftriaxone, ampicillin, ertapenem, imipenem and aztreonam were 100.0%. The lowest drug resistance rate of sulfamethazol / trimethoprim was 32.0, followed by amikacin and tobrazin were 68.0%. The improved Hodge test was positive in 20 strains. SHV gene was detected in 20 strains, CTX-M gene was detected in 15 strains, KPC-2 gene gene was detected in 1 strain, IMP-4 gene was detected in 1 strain. NDM-1 gene was detected in 3 strains, but VIM-OXA-48 gene was not detected. The 25 strains were divided into 6 strains, which were Ampelopenem, and there were 1 strain of 1 strain of Amipenem resistant Klebsiella pneumoniae. Conclusion Imipenem-resistant Klebsiella pneumoniae is a serious multidrug resistant strain of Klebsiella pneumoniae which is resistant to imipenem. The production of 尾 -lactamases is the main mechanism of drug resistance of the strains, and three strains of clonal transmissible bacteria have detected NDM-1 genes, which should be paid more attention to by relevant departments.
【作者单位】：中南大学湘雅医院感染控制中心;中南大学湘雅医院检验科;
【基金】：湖南省科技计划基金资助项目(2012SK3200)
【分类号】：R446.5
【正文快照】： 肺炎克雷伯菌是重要的条件致病菌,随着大量抗菌药物的使用,肺炎克雷伯菌对β-内酰胺类药物的耐药率不断上升。碳青霉烯类药物几乎可以分解所有的β-内酰胺类抗菌药物,是治疗产超广谱β-内酰胺酶(ESBLs)和AmpC酶等耐药菌引起的感染的重要药物,近年来,其耐药率不断上升。本研究

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