耐碳青霉烯类肺炎克雷伯菌获得性耐药元件指标聚类分析

发布时间：2018-03-26 07:31

  本文选题：肺炎克雷伯菌　切入点：耐碳青霉烯类　出处：《中华医院感染学杂志》2016年04期

【摘要】：目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)对β-内酰胺类与氨基糖苷类药物的耐药相关基因与可移动遗传元件存在状况,以及获得性耐药相关基因与可移动遗传元件存在的相互关系。方法收集2014年1-12月住院患者标本中分离到的20株CRKP,用gyrA测序后BLASTn比对确认菌种,再采用聚合酶链反应(PCR)法分析40种β-内酰胺酶基因、6种氨基糖苷类修饰酶、6种16SrRNA甲基化酶、12种可移动遗传元件遗传标记和blaKPC型与ISKpn6连锁检测,并对检测结果作指标聚类分析。结果 20株CRKP对9种β-内酰胺类与氨基糖苷类均耐药;获得性耐药相关基因与可移动遗传元件标记每株均有阳性发现,共检出4种β-内酰胺酶基因(blaTEM、blaSHV、blaKPC、blaIMP),1种氨基糖苷类修饰酶基因(aac(3)-Ⅱ)、1种16SrRNA甲基化酶基因(rmtB),8种可移动遗传元件遗传标记(traA、trbC、tnp513、IS26、IS903、ISEcp1、ISKpn6、intⅠ1);5株CRKP blaKPC-ISKpn6连锁检测为阳性;指标聚类分析提示,β-内酰胺酶基因blaIMP与tnp513强关联;β-内酰胺酶基因blaKPC、blaSHV及16S rRNA甲基化酶基因rmtB与ISKpn6、ISEcp1、traA强关联;氨基糖苷类修饰酶基因aac(3)-Ⅱ与IS26、IS903、intⅠ1、trbC强关联。结论肺炎克雷伯菌耐药表型与基因型结果相符,对β-内酰胺类与氨基糖苷类药物的耐药与可移动遗传元件介导的blaTEM、blaSHV、blaKPC、blaIMP、aac(3)-Ⅱ、rmtB相关。
[Abstract]:Objective to investigate the presence of drug-resistant genes and removable genetic elements in 尾 -lactam and aminoglycoside drugs in Klebsiella carbapenem resistant Klebsiella pneumoniae (CRKP). Methods Twenty strains of CRKPs isolated from hospitalized patients from January to December 2014 were collected and identified by BLASTn comparison after gyrA sequencing. Polymerase chain reaction (PCR) was used to analyze 40 尾 -lactamases, 6 aminoglycoside modified enzymes, 6 16SrRNA methylases, 12 transportable genetic element genetic markers and blaKPC linkage to ISKpn6. Results 20 strains of CRKP were resistant to 9 kinds of 尾 -lactams and aminoglycosides, and acquired drug-resistance-related genes and mobile genetic element markers were positive for each strain, the results showed that 20 strains of CRKP were resistant to 9 kinds of 尾 -lactams and aminoglycosides. A total of 4 尾 -lactamases genes were identified. One aminoglycoside modified enzyme gene was identified as CRKP blaKPC-ISKpn6 linkage analysis of 8 transportable genetic element genetic markers, namely, TracbCnp513CnP513IS26IS903Ecp513IS903Ecp513IS26IS903 and CRKP blaKPC-ISKpn6 linkage analysis of 5 strains of CRKP mRNAs, and the results showed that the four 尾 -lactamases genes and 1 16SrRNA methylase gene were identified as CRKP linkage markers, and the results showed that the four 尾 -lactamases genes were identified to be positive for the detection of CRKP blaKPC-ISKpn6 linkage to 5 strains of CRKP gene, namely, tmtmttp513Cnp513tp513IS26IS903. Cluster analysis showed that 尾 -lactamase gene blaIMP was strongly associated with tnp513, and 尾 -lactamase gene blaKPC-blaSHV and 16s rRNA methylase gene rmtB were strongly associated with ISKpn6 ISEcp1a, while 尾 -lactamase gene blaIMP was strongly associated with tnp513, and 尾 -lactamase gene was strongly associated with ISKpn6 ISEcp1 gene and 16s rRNA methylase gene rmtB. The aminoglycoside modified enzyme gene aacan3t- 鈪，

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