产KPC型碳青霉烯酶肺炎克雷伯菌的检测及感染现状

发布时间：2018-05-04 23:30

本文选题：肺炎克雷伯菌 + 碳青霉烯酶　；参考：《中国实验诊断学》2017年02期

【摘要】：目的通过对碳青霉烯类耐药肺炎克雷伯菌(CRKP)的检测及病例分析,了解CRKP对碳青霉烯类抗菌药物的耐药机制及感染现状,为临床抗感染治疗及院感控制提供依据。方法应用BD phoenixTM-100全自动细菌鉴定及药敏分析系统筛选耐亚胺培南或美罗培南的肺炎克雷伯菌,然后通过改良Hodge试验检测碳青霉烯酶表型,用PCR方法检测KPC、NDM-1和OXA-48碳青霉烯酶耐药基因。结果 71株CRKP改良Hodge试验阳性56株,阳性率为78.9%,PCR结果显示:71株CRKP中有53株检测出blaKPC-2基因、8株blaNDM-1基因、2株blaOXA-48基因;标本来源主要见于ICU、肾内科和神经内科等病房的痰液、尿液和引流液标本;药敏结果显示:所分离的71株CRKP除了对阿米卡星、替加环素和多粘菌素的耐药率较低外,对其他抗菌药物的耐药率均70%。结论 CRKP临床分布较为广泛,多药耐药严重,其耐药基因以产KPC-2型为主,但同时还出现了NDM-1和OXA-48基因型,应加强监控。
[Abstract]:Objective to investigate the mechanism of CRKP resistance to carbapenem antibiotics and the current situation of infection through detection and case analysis of carbapenem resistant Klebsiella pneumoniae, and to provide evidence for clinical anti-infective treatment and hospital control. Methods Klebsiella pneumoniae resistant to imipenem or meropenem were screened by BD phoenixTM-100 automatic bacteria identification and drug sensitivity analysis system, and carbapenem phenotypes were detected by modified Hodge test. KPC-NDM-1 and OXA-48 carbapenem resistance genes were detected by PCR. Results there were 56 positive strains of CRKP modified Hodge test, and the positive rate was 78.9%. The results showed that 53 of the 71 strains of CRKP had blaKPC-2 gene and 8 strains of blaNDM-1 gene and 2 strains of blaOXA-48 gene, the samples were mainly found in sputum of ICU, Department of Nephrology and Neurology, etc. The drug sensitivity of 71 strains of CRKP, except for amikacin, tegacyclin and polymyxin, was low, and the drug resistance rates to other antimicrobial agents were all 70%. Conclusion the clinical distribution of CRKP is widespread and the multidrug resistance is serious. The main gene of CRKP is KPC-2, but there are NDM-1 and OXA-48 genotypes, so the monitoring should be strengthened.
【作者单位】：海军青岛第二疗养院感控科;青岛大学附属青岛市立医院检验科;青岛大学附属医院检验科;
【分类号】：R440

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