产金属β-内酰胺酶肺炎克雷伯菌的相关整合子和同源性分析

发布时间：2018-03-06 21:14

本文选题：肺炎克雷伯菌　切入点：金属β-内酰胺酶　出处：《中国抗生素杂志》2013年10期 　论文类型：期刊论文

【摘要】：目的调查我院2010年1月—2010年12月临床分离的产金属β-内酰胺酶肺炎克雷伯菌的耐药性、同源性、金属酶基因型及相关整合子。方法收集我院住院患者临床分离非重复对碳青霉烯类抗生素不敏感的肺炎克雷伯菌16株;乙二胺四乙酸(EDTA)协同实验筛选产金属β-内酰胺酶菌株;采用PCR法扩增金属酶和3类整合子基因,测序确定金属酶基因型;应用肠杆菌基因间重复一致序列聚合酶链反应(ERIC-PCR)分析产酶菌株间的同源性;琼脂倍比稀释法进行常用抗菌药物敏感性实验。结果 16株对碳青霉烯类不敏感的肺炎克雷伯菌中EDTA协同实验阳性的有5株,PCR扩增测序有4株产IMP-8型金属β-内酰胺酶,其中3株携带的IMP-8基因位于I类整合子上;未检测到II、III类整合子和VIM、GIM、SIM、SPM、NDM金属酶基因。ERIC-PCR结果显示产酶株分为2种基因型,A型3株,均分离于呼吸内科重症监护病房患者的痰标本;B型1株。药敏实验结果显示:A型的3株对青霉素类、头孢菌素类抗生素、氨曲南及环丙沙星完全耐药,其中K2菌株对亚胺培南、美罗培南中介,但对阿米卡星敏感;K1、K4菌株对亚胺培南、美罗培南及阿米卡星耐药。B型的K3菌株除氨曲南外对其他β-内酰胺类抗生素均高水平耐药,但对阿米卡星及环丙沙星均敏感。结论该院呼吸内科重症监护病房存在产IMP-8型金属β-内酰胺酶肺炎克雷伯菌克隆传播,且耐药基因位于I类整合子上,医护人员应予以高度关注,注意进行临床检测和监控,并及时采取有效措施。
[Abstract]:Objective to investigate the clinical isolates in our hospital in January 2010 December 2010 of the metallo beta lactamase producing Klebsiella pneumoniae resistance, homology, metal enzyme gene and corresponding integron. Clinical isolates from patients with non repetition is not sensitive to carbapenem antibiotics of 16 strains of Klebsiella pneumoniae in our hospital; ethylenediaminetetraacetic acid (EDTA) collaborative experimental screening of metallo beta lactamase producing strains; using PCR amplified metal enzyme and class 3 integron gene sequencing MBL genotype; application of enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) analysis of homologous enzyme production strains; agar dilution method commonly used antimicrobial susceptibility test. Results 16 strains of EDTA are not sensitive to carbapenems of Klebsiella pneumoniae in cooperative experiment positive 5 strains, 4 strains of PCR were amplified by IMP-8 metal beta lactam enzyme, the In 3 strains carrying IMP-8 gene located on the class I integron; II was not detected, III integron and VIM, GIM, SIM, SPM, NDM metal enzyme gene.ERIC-PCR results showed that the enzyme producing strains into 2 genotypes, 3 strains of A were isolated from sputum specimens of patients with respiratory medicine intensive care ward; 1 strains of B. The results of drug sensitivity test showed that A type 3 strains of penicillins, cephalosporins, aztreonam and ciprofloxacin resistant strains of K2 completely, including imipenem, meropenem intermediary, but sensitive to Amikacin; K1, K4 strains to imipenem, meropenem and Amikacin resistant strain K3.B in addition to aztreonam to other beta lactam antibiotics have a high level of resistance, but were sensitive to Amikacin and ciprofloxacin. Conclusion the respiratory ICU is producing IMP-8 type metallo beta lactamase Klebsiella pneumoniae clone spread and resistant gene The medical and nursing staff should pay high attention to the I integrons, pay attention to clinical testing and monitoring, and take effective measures in time.

【作者单位】：重庆医科大学附属第一医院感染科;
【基金】：重庆市自然科学基金资助项目(CSTC,2007BB5317) 重庆市教委科学技术研究项目基金资助项目(KJ070308)
【分类号】：R378

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