碳青霉烯类耐药肺炎克雷伯菌多位点序列分型和不同ST分型感染患者的临床特点

发布时间：2018-10-16 14:16

【摘要】：目的对临床分离的碳青霉烯类耐药肺炎克雷伯菌(CR-KPN)进行多位点序列分型(MLST),同时研究不同ST分型感染患者的临床特点。方法收集2013年1月-2015年6月辽宁省为主5所医院临床分离的61株CR-KPN,采用微量肉汤稀释法测定受试菌株对14种抗菌药物的敏感性。应用PCR基因扩增技术及DNA测序方法对受试菌株进行碳青霉烯酶基因检测。通过对受试菌株进行MLST,探讨其克隆相关性和分子流行病学特征。同时分析不同ST分型下CR-KPN的耐药特点、耐药机制及菌株感染的临床特点。结果 MLST分型显示61株CR-KPN共有18种ST分型,ST11为优势型别(53.3%),研究同时发现这部分ST11型菌株更容易对碳青霉烯类抗生素耐药且MIC值较高,大部分产KPC-2型碳青霉烯酶。单因素分析提示ST11组患者在ICU接受治疗所占的比例及机械通气的使用率高于非ST11组,差异具有统计学意义。其他ST型中ST2033、ST2135、ST2193、ST2194、ST2195、ST2196为世界范围内首次注册,其中ST2193、ST2194、ST2195与ST11有密切的亲缘性。临床资料提示同一所医院同一时期以相同克隆流行为主。结论 MLST显示CR-KPN共有18种ST型别,ST11为优势型别,结合临床资料发现同一所医院同一时期以相同克隆流行为主,提示CR-KPN有局部播散的风险。鉴于临床资料分析提示接受过ICU治疗和机械通气的患者容易发生CR-KPN菌株(特别是ST11型)感染的风险,此类患者应引起临床的广泛重视。
[Abstract]:Objective to study the clinical characteristics of Klebsiella pneumoniae (CR-KPN) infected patients with different ST typing by multilocus sequence (MLST), typing. Methods from January 2013 to June 2015, 61 strains of CR-KPN, isolated from 5 hospitals in Liaoning Province were collected and their susceptibility to 14 antimicrobial agents was determined by broth dilution method. PCR gene amplification and DNA sequencing were used to detect carbapenase gene in the tested strains. The clone correlation and molecular epidemiological characteristics of the tested strains were investigated by MLST,. At the same time, the characteristics of drug resistance, the mechanism of drug resistance and the clinical characteristics of strain infection in different ST typing were analyzed. Results MLST typing showed that there were 18 ST genotypes in 61 CR-KPN strains, and ST11 was the dominant type (53.3%). It was also found that the ST11 strains were more resistant to carbapenem antibiotics and had higher MIC value, and most of them produced KPC-2 carbapenem. Univariate analysis showed that the proportion of patients treated with ICU and the utilization rate of mechanical ventilation in ST11 group were higher than those in non-ST11 group, and the difference was statistically significant. In other ST types, ST2033,ST2135,ST2193,ST2194,ST2195,ST2196 was registered for the first time worldwide, in which ST2193,ST2194,ST2195 was closely related to ST11. The clinical data suggested that the same clone was dominant in the same hospital at the same time. Conclusion MLST shows that there are 18 ST types in CR-KPN, and ST11 is the dominant type. Combined with clinical data, it is found that the same clone prevalence is dominant in the same hospital at the same time, suggesting that CR-KPN has the risk of local dissemination. In view of the clinical data analysis indicated that the patients who had received ICU treatment and mechanical ventilation were prone to the risk of CR-KPN strains (especially ST11 type) infection, this kind of patients should be paid more attention to in clinic.
【作者单位】：中国医科大学附属第一医院感染科;中国医科大学附属第一医院检验科;辽宁省人民医院检验科;中国医科大学附属盛京医院;大连医科大学附属第一医院检验科;哈尔滨医科大学附属第一医院检验科;
【分类号】：R446.5

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