ICU患者感染多药耐药肺炎克雷伯菌的耐药性分析

发布时间：2018-03-30 08:04

本文选题：肺炎克雷伯菌　切入点：肠道　出处：《中华医院感染学杂志》2016年06期

【摘要】：目的了解重症监护病房(ICU)患者肠道与呼吸道感染的多药耐药肺炎克雷伯菌耐药表型及基因,探讨ICU患者肺部感染与肠道细菌的关联,为ICU患者的呼吸道医院感染及控制提供重要依据。方法收集2014年1-12月医院50例肺部感染患者,ICU住院患者粪便或肛拭子、痰液标本各50份,对送检标本使用ESBLs显色筛选平板及血平板培养基进行培养及多药耐药菌的筛选,经VITEK-2Compact全自动细菌分析仪进行鉴定及药敏试验,对多药耐药菌进行耐药性比较,用PCR检测常见β-内酰胺酶耐药基因,用ERIC-PCR进行同源性分析。结果肛拭子检出肺炎克雷伯菌50株,其中产ESBLs及泛耐药肺炎克雷伯菌分别22、6株,各占44.0%、12.0%;呼吸道标本中检出肺炎克雷伯菌38株,其中产ESBLs、泛耐药肺炎克雷伯菌分别21、4株,各占55.3%、10.5%;肛拭子分离肺炎克雷伯菌对CTX-M、TEM、SHV基因的携带率分别为48.0%、44.0%、18.0%,呼吸道分离耐药肺炎克雷伯菌对CTX-M、TEM、SHV基因的携带率分别为36.8%、44.7%、21.1%,两者之间差异无统计学意义;对肠道及呼吸道分离的肺炎克雷伯菌同源性分析发现同源性较高。结论医院ICU患者呼吸道与肠道分离肺炎克雷伯菌高度同源,且两者携带多药耐药基因存在较高一致性。
[Abstract]:Objective to investigate the phenotype and gene of multidrug resistant Klebsiella pneumoniae in patients with ICU, and to explore the relationship between pulmonary infection and intestinal bacteria in patients with ICU. Methods the feces and anal swabs of 50 patients with pulmonary infection in our hospital from January to December 2014 were collected, including 50 sputum samples. ESBLs plate and blood plate medium were used for culture and screening of multidrug resistant bacteria. The drug resistance of multidrug resistant bacteria was compared by VITEK-2Compact automatic bacterial analyzer and drug sensitivity test. Results 50 strains of Klebsiella pneumoniae were detected in anal swab, among which 226 strains produced ESBLs and 6 strains of pan-resistant Klebsiella pneumoniae. 38 strains of Klebsiella pneumoniae were detected in respiratory tract samples, among which ESBLsproducing strains and pan-drug-resistant Klebsiella pneumoniae strains were 21 or 4 strains, respectively. The carrying rate of CTX-Mtems SHV gene in anal swabs was 48.0 and 18.0, respectively. The carrying rate of CTX-MTEMT-SHV gene in respiratory isolated Klebsiella pneumoniae was 36.844.70.There was no significant difference between the two groups. The homology analysis of Klebsiella pneumoniae isolated from intestinal tract and respiratory tract showed that there was a high homology between the respiratory tract and intestinal isolated Klebsiella pneumoniae in hospital ICU patients.
【作者单位】：金华市人民医院检验科;金华市人民医院医院感染科;
【基金】：国家自然科学基金青年基金资助项目(81000756) 浙江省科技厅基金资助项目(2012C33023) 金华市科技局基金资助项目(2012-3-049)
【分类号】：R446.5

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