碳青霉烯耐药肺炎克雷伯菌耐药机制及分子流行病学研究

发布时间：2018-04-05 03:02

本文选题：肺炎克雷伯菌　切入点：碳青霉烯酶　出处：《安徽医科大学学报》2016年06期

【摘要】：目的探讨临床分离的耐碳青霉烯肺炎克雷伯菌的耐药基因及分子流行病学研究。方法收集并鉴定临床分离非重复碳青霉烯耐药肺炎克雷伯菌株44株。采用Vitek 2compact全自动微生物鉴定药敏分析仪鉴定进行常规药敏试验,改良Hodge试验检测KPC型碳青霉烯酶,EDTA协同法检测金属β-内酰胺酶,聚合酶链反应(PCR)法检测细菌携带的耐药基因。肠杆菌基因间重复性共有序列ERIC-PCR对菌株进行同源性分析,了解其分子流行病学特征。结果44株肺炎克雷伯菌对碳青霉烯类、青霉素类、头孢菌素类和氨曲南等抗菌药物显示了较高的耐药性。改良Hodge试验阳性41株,金属酶检测试验结果均为阴性。PCR结果显示,临床分离的耐碳青霉烯肺炎克雷伯菌以KPC-2型为主,共42株。ERIC-PCR将44株肺炎克雷伯菌分为14型,以Ⅰ型为主,共18株,集中于重症监护室(ICU)和神经外科。结论分离的碳青霉烯耐药肺炎克雷伯菌对临床常用抗菌药物表现出高水平耐药;其耐药机制主要是该类细菌产KPC-2碳青霉烯酶,ICU与其它科室的患者频繁转诊治疗可能是导致碳青霉烯耐药肺炎克雷伯菌在全院范围播散流行的主要原因。
[Abstract]:Objective to investigate the drug resistance gene and molecular epidemiology of Klebsiella pneumoniae isolated from clinical isolates.Methods 44 Klebsiella pneumoniae strains were collected and identified.The routine drug sensitivity test was carried out by Vitek 2compact automatic microbiological identification analyzer. The improved Hodge test was used to detect metal 尾 -lactamases by KPC carbapenase and polymerase chain reaction polymerase chain reaction (PCR) to detect the drug-resistant genes carried by bacteria.The homology of Enterobacter spp was analyzed by ERIC-PCR, and the molecular epidemiologic characteristics of Enterobacter spp.Results 44 strains of Klebsiella pneumoniae showed high resistance to carbapenems penicillin cephalosporins and aztreonam.There were 41 positive strains in modified Hodge test. The results of metallozyme test showed that Klebsiella pneumoniae was mainly KPC-2 type isolated from clinical isolates. 44 strains of Klebsiella pneumoniae were classified into 14 types and I type by using the improved Hodge test, and 42 strains of Klebsiella pneumoniae were identified by .ERIC-PCR.A total of 18 strains, concentrated in intensive care unit (ICU) and neurosurgery.Conclusion Klebsiella pneumoniae isolated from carbapenem showed high level of resistance to antibiotics commonly used in clinic.The mechanism of drug resistance is mainly due to the frequent referrals of patients with KPC-2 carbapenem producing in ICU and other departments, which may be the main cause of the spread of Klebsiella pneumoniae in the whole hospital.
【作者单位】：安徽医科大学第二附属医院检验科;
【基金】：国家自然科学基金(编号:81171662)
【分类号】：R446.5

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