患者及相关环境分离CRKP的耐药谱与同源性

发布时间：2018-06-27 09:46

本文选题：肺炎克雷伯菌 + 碳青霉烯酶类抗生素　；参考：《中国感染控制杂志》2017年08期

【摘要】：目的了解某医疗机构耐碳青霉烯类肺炎克雷伯菌(CRKP)感染患者临床分离株与环境分离株的同源性。方法收集该院1例患者分离的CRKP与该患者周围环境中检出的4例肺炎克雷伯菌,测定5株菌对临床上常用抗菌药物的敏感性,利用改良Hodge试验和CIM(Carbapenem Inactivation Method)试验检测5株菌产碳青霉烯酶情况,采用脉冲场凝胶电泳(PFGE)对其进行同源性分析。结果药敏试验结果显示,5株肺炎克雷伯菌(1株来自患者,4株来自于患者所在的病房环境,分离自护工手、溶液瓶口、升降扶手、床栏杆)除对头霉素类、氨基糖苷类抗生素的药敏结果不一致外,对其他各类抗菌药物均表现为耐药。改良Hodge试验和CIM试验证实5株菌均产碳青霉烯酶;PFGE结果显示,病房溶液瓶口、床栏杆、病床升降扶手同患者标本分离的CRKP电泳图谱一致,为同一菌株,而护工手同患者标本分离的CRKP电泳图谱有2条条带的差异,其菌株间有相近的关系。结论患者及其周围环境检出同一种CRKP,应严格执行医院感染控制制度,隔离感染患者,加强环境的清洁与消毒,避免医院感染暴发。
[Abstract]:Objective to investigate the homology between clinical isolates and environmental isolates from patients with Klebsiella pneumoniae (CRKP) infection in a medical institution. Methods one CRKP isolated from one patient and four Klebsiella pneumoniae isolated in the surrounding environment of the patient were collected, and the sensitivity of 5 strains of Klebsiella pneumoniae to the antibiotics commonly used in clinic was determined. The improved Hodge test and CIM (Carbapenem inactivation method) test were used to detect the carbapenem producing enzymes of 5 strains, and their homology was analyzed by pulsed field gel electrophoresis (PFGE). Results the drug sensitivity test showed that 5 strains of Klebsiella pneumoniae (1 strain from the patient and 4 strains from the ward of the patient were isolated from the hands of the nurse, the mouth of the solution bottle, the lifting handrail, the bed railing) except for the cephalomycin. The drug sensitivity of aminoglycoside antibiotics was not consistent, but resistance to other antimicrobial agents was found. The improved Hodge test and CIM test confirmed that all of the five strains produced carbapenem enzyme PFGE. The results showed that the electrophoresis patterns of CRKP isolated from the bottle mouth, bed railings and bed handrails of the five strains were the same as those isolated from the patient's specimen. There were two bands in CRKP electrophoretogram between nurse hand and patient specimen, and there was similar relationship between the two strains. Conclusion the same CRKPs can be detected in patients and their surroundings. The hospital infection control system should be strictly carried out, the infection patients should be isolated, and the environment should be cleaned and disinfected so as to avoid the outbreak of nosocomial infection.
【作者单位】：第三军医大学附属西南医院;重庆市人民医院;
【基金】：国家自然科学基金项目(No.71373280) 第三军医大学临床创新基金项目(SWH2013LC08,SWH2014LC31)
【分类号】：R446.5

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