质粒型AmpC酶DHA基因在耐药肺炎克雷伯菌中的流行研究

发布时间：2018-04-22 17:34

本文选题：肺炎克雷伯菌 + 耐药　；参考：《中华医院感染学杂志》2017年16期

【摘要】：目的调查对常用抗菌药物耐药肺炎克雷伯菌(DRK)获得性耐药基因及相关可移动遗传元件的携带状况及菌株间的亲缘关系。方法 20株耐药肺炎克雷伯菌均分离自医院2015年1-12月住院患者痰标本,用K-B法测定抗菌药物的敏感性,采用聚合酶链反应(PCR)及序列分析的方法分析24种β-内酰胺类获得性耐药基因、11种氨基糖苷类获得性耐药基因、10种可移动遗传元件遗传标记,阳性耐药基因测序后直接作BLAST比对,耐药基因检测结果作样本聚类分析(UPGMA法)。结果 20株耐药肺炎克雷伯菌对β-内酰胺类、氨基糖苷类、喹诺酮类均耐药,但对碳青霉烯类均敏感;20株菌均检出β-内酰胺类获得性耐药基因,阳性率为100.0%,共检出6种β-内酰胺酶基因,blaDHA群基因检出率为最高90.0%;每株也均检出氨基糖苷类修饰酶基因,阳性率为100.0%,共检出4种氨基糖苷类获得性耐药基因,ant(3″)-Ⅰ群基因检出率为最高90.0%,但16SrRNA甲基化基因未检出;可移动遗传元件标记基因每株也均有检出,共检出7种可移动遗传元件标记基因,其中tnp513、IS26、IS903、ISEcp1、intⅠ1阳性率均为100.0%,trbC阳性率95.0%;样本聚类分析显示,该组菌株有明显的聚集性,分A与B二个群,B群又可分为B-1、B-2两个亚群,B-2亚群存在二个克隆传播,其中5-6号株均携带10种基因,4-7-8-9-13-14-15-16-17-18-19-20号株均携带9种基因。结论 20株耐药肺炎克雷伯菌同时携带了β-内酰胺类获得性耐药基因、氨基糖苷类修饰酶基因和可移动遗传元件标记基因,是对β-内酰胺类和氨基糖苷类产生耐药的重要原因,该组菌检出的2个克隆高度疑似医院感染,同一克隆菌株携带相同基因。
[Abstract]:Objective to investigate the carrying status of the acquired resistance genes of Klebsiella pneumoniae (DRK) and related mobile genetic components and the relationship among the strains. Methods 20 strains of Klebsiella pneumoniae were isolated from hospital sputum specimens in hospital in 1-12 months of 2015, and the sensitivity of antibiotics was determined by K-B method. Enzyme chain reaction (PCR) and sequence analysis were used to analyze 24 beta lactam acquired resistance genes, 11 aminoglycoside resistant genes, 10 types of genetic markers for mobile genetic elements, direct BLAST alignment after sequencing of positive resistance genes, and cluster analysis of resistance gene detection results (UPGMA method). Results of 20 resistant pneumonia Klebsiella was resistant to beta lactam, aminoglycosides and quinolones, but was sensitive to carbapenems. 20 strains detected the beta lactam resistant gene, the positive rate was 100%, 6 beta lactamase genes were detected, and the detection rate of blaDHA group genes was the highest 90%. The rate of sex was 100%, and 4 aminoglycoside resistant genes were detected. The detection rate of ant (3 ") - I gene was the highest, but the 16SrRNA methylation gene was not detected. The mobile genetic element marker genes were detected and 7 kinds of movable genetic element markers were detected. The positive rates of tnp513, IS26, IS903, ISEcp1 and int i 1 were all positive. For 100%, the positive rate of trbC was 95%. Sample cluster analysis showed that the group had obvious aggregation, A and B two groups, and B group could be divided into B-1, B-2 two subgroups, B-2 subgroup with two clones, of which 10 genes were carried in 5-6 strains and 9 genes were carried in 4-7-8-9-13-14-15-16-17-18-19-20 strain. Conclusion 20 resistant pneumonia Klein Beta lactam acquired resistance gene, aminoglycoside modifying enzyme gene and movable genetic element marker gene were also carried by primary bacteria, which was an important cause of resistance to beta lactam and aminoglycosides. The 2 clones detected by the group were highly suspected of nosocomial infection and the same cloned strain carried the same gene.

【作者单位】：孝感市中心医院检验科;武汉大学人民医院检验科;
【分类号】：R440

【参考文献】