多重耐药HvKP菌株临床感染分布及耐药机制

发布时间：2018-05-12 15:47

本文选题：肺炎克雷伯菌 + 高毒力　；参考：《中国老年学杂志》2017年12期

【摘要】：目的探讨高毒力肺炎克雷伯菌新型变种(Hv KP)临床感染分布和耐药机制。方法肺炎克雷伯菌180株为实验菌株并筛选Hv KP菌株;多位点序列分析和ERIC-PCR检测Hv KP菌株的分子流行病学特征;检测实验菌株对常用抗菌药物的敏感性,梅里埃ETEST药敏纸条检测美罗培南和厄他培南的MIC值;PCR和基因测序检测耐药基因型、血清荚膜分型、毒力基因;黏液丝试验检测菌株高黏液型表型。结果共分离出11株Hv KP菌株,其中医院获得性Hv KP菌株感染率明显高于社区获得性感染率(P0.05);明确Hv KP菌株感染前碳青霉烯类使用率明显高于其他类抗生素(P0.05)。11株Hv KP中检出5种ERIC-MLST克隆分型,主要为A/ST23、B/ST263分型。PCR和测序显示,广谱β-内酰胺酶基因中,9株携带bla TEM-1、5株携带bla CTX-M-3、5株携带bla CTX-M-14、3株携带bla SHV-12;质粒介导喹诺酮类耐药基因中,8株携带qnr A1、6株携带qnr B4、6株携带qnr S4、2株携带acc-Ib-cr。荚膜血清型为K1的10株、K2的1株。毒力基因中mag A、rmp A、产气菌素的检出率明显高于其他毒力基因(P0.05)。结论 A/ST23、B/ST263型分子克隆是引发多重耐药Hv KP菌株的机制之一且存在强毒性血清型和多种毒力基因。
[Abstract]:Objective to investigate the distribution of clinical infection and the mechanism of drug resistance of a new variant of Klebsiella pneumoniae Hv KP. Methods 180 strains of Klebsiella pneumoniae were used as experimental strains and HvKP strains were screened. The molecular epidemiological characteristics of HvKP strains were analyzed by multilocus sequence analysis and ERIC-PCR. Meropenem ETEST was used to detect the MIC value of meropenem and ertapenem and gene sequencing was used to detect the genotypes of drug resistance, serum capsule typing, virulence gene, and myxofilament test to detect the high mucus phenotype of the strain. Results A total of 11 HvKP strains were isolated. The infection rate of nosocomial HvKP was significantly higher than that of community-acquired infection, and the utilization rate of carbapenes was significantly higher than that of other antibiotics P0.05. 11 strains of HvKP. PCR and sequencing showed that 9 strains of broad-spectrum 尾 -lactamase gene carried bla TEM-1, 5 strains of bla CTX-M-3, 5 strains of bla CTX-M-14C, 3 strains of bla SHV-12, 8 strains of plasmid mediated quinolone resistance gene carrying qnr A16, 6 strains of qnr B4b-6, carrying qnr S4b-2 strains, carrying acc-Icr-12. The capsule serotype K1 was 1 strain of K2 strain. The detection rate of mag rmp A and aerogenin in virulence gene was significantly higher than that in other virulence genes (P0.05). Conclusion the molecular cloning of A / St 23 B / T 263 is one of the mechanisms of inducing multidrug resistance of HvKP, and there are many virulence genes and serotypes with strong toxicity.
【作者单位】：天津医科大学医学检验学院;天津中医药大学;
【分类号】：R446.5

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