文献类型：期刊文献

中文题名：甘肃某三级医院住院患者耐碳青霉烯类肺炎克雷伯菌临床分布及耐药性分析

英文题名：Distribution and antibiotic resistance profile of the carbapenem-resistant Klebsiella pneumoniae isolated from inpatients in a tertiary hospital in Gansu

作者：蒋晓颖[1];王东亮[1];魏莲花[2];李丹[3];胡一弋[3];何天鹏[1];张丽琴[2];赵婧[2];袁媛[2]

第一作者：蒋晓颖

机构：[1]甘肃中医药大学第一临床医学院,兰州730000;[2]甘肃省人民医院重症医学1科;[3]复旦大学附属华山医院抗生素研究所

第一机构：甘肃中医药大学临床医学院

年份：2021

卷号：21

期号：4

起止页码：449

中文期刊名：中国感染与化疗杂志

外文期刊名：Chinese Journal of Infection and Chemotherapy

收录：CSTPCD;;Scopus;北大核心:【北大核心2020】；CSCD:【CSCD2021_2022】；

基金：甘肃省卫生行业项目(2020-021)。

语种：中文

中文关键词：耐碳青霉烯类肺炎克雷伯菌;感染特征;抗菌药物;耐药性

外文关键词：carbapenem-resistant Klebsiella pneumoniae;characteristics of infection;antimicrobial agent;antimicrobial resistance

摘要：目的分析住院患者临床分离耐碳青霉烯类肺炎克雷伯菌(CRKP)的分布及耐药性,为临床CRKP的预防、控制及治疗提供更多的参考依据。方法收集2018年1月—2019年8月甘肃省人民医院临床分离的CRKP菌株,采用表型筛选试验对分离菌进行产A类、B类碳青霉烯酶筛选。PCR方法扩增碳青霉烯酶基因(bla_(KPC)、bla_(NDM)、bla_(IMP)、bla_(VIM)、bla_(GES)、bla_(OXA-48))、超广谱β内酰胺酶基因(bla_(SHV)、bla_(CTX-M))、头孢菌素酶基因(bla_(MOX)、bla_(CIT)、bla_(DHA)、bla_(ACC)、bla_(EBC)、bla_(FOX))、膜孔蛋白基因(Ompk35、Ompk36),PCR扩增产物进行测序以明确基因亚型,脉冲场凝胶电泳(PFGE)对分离菌株进行同源性分析。同时结合临床资料,对其分布及耐药情况进行统计分析。结果 2018年1月—2019年8月住院患者临床分离的肺炎克雷伯菌共611株,CRKP菌株19株,检出率为3.1%,其中2018年6株、2019年13株。19株CRKP主要分离自成人重症监护病房(ICU)(10/19,52.6%);主要分离于痰液标本(57.9%),其次为尿液、血液标本(各占10.5%)。药敏结果显示19株CRKP均为多重耐药或泛耐药菌株,对常用抗菌药物的耐药率均高于50%。PCR结果显示9株CRKP携带A类碳青霉烯类耐药基因bla_(KPC-2);19株CRKP均检出超广谱β内酰胺酶基因,其中bla_(SHV)型11株、bla_(CTX-M)型10株;8株CRKP头孢菌素类耐药基因bla_(DHA-1)阳性。膜孔蛋白Ompk35基因缺失6株,Ompk36基因缺失14株。19株CRKP经PFGE分型可分为15种不同克隆型。结论该院CRKP对多种抗菌药物耐药率均较高,且对碳青霉烯类抗菌药物耐药机制复杂,需引起临床及感控部门的高度重视。
Objective To analyze the distribution and antibiotic resistance profile of the carbapenem-resistant Klebsiella pneumoniae(CRKP)strains isolated from inpatients,so as to support the prevention,control,and treatment of CRKP infections.Methods CRKP strains were isolated from inpatients in Gansu Provincial People’s Hospital from January 2018 to August 2019.Phenotypic screening test was used to identify the bacterial strains producing Class A or Class B carbapenemase.PCR method was applied to amplify carbapenemase genes(bla_(KPC),bla_(NDM),bla_(IMP),bla_(VIM),bla_(GES),and bla_(OXA-48)),extended-spectrumβ-lactamase genes(blaSHV,and blaCTX-M type),cephalosporinase genes(bla_(MOX),bla_(CIT),bla_(DHA),bla_(ACC),bla_(EBC),and bla_(FOX)),and outer membrane porin genes(Ompk35,Ompk36).PCR amplification products were sequenced to identify the genotype.Pulsed-field gel electrophoresis(PFGE)was used to analyze the homology of the isolates.Distribution and antibiotic resistance profile were analyzed in combination with clinical data.Results A total of 611 strains of K.pneumoniae were isolated from inpatients from January 2018 to August 2019,including 19(3.1%)CRKP strains,specifically 6 in 2018 and 13 in 2019.More than half(52.6%,10/19)of the CRKP strains were isolated from adults in ICU.The strains were mostly isolated from sputum(57.9%),followed by urine(10.5%)and blood specimens(10.5%).Antimicrobial susceptibility results showed that CRKP were multidrug-resistant or pandrug-resistant strains.More than 50%of the CRKP strains were resistant to the commonly used antibacterial agents.PCR results showed that 9 CRKP strains carried Class A carbapenem resistance gene bla_(KPC-2).Extended-spectrumβ-lactamase genes were identified in all the 19 CRKP strains,including bla_(SHV) type in 11 strains and blaCTX-M type in 10 strains.Cephalosporin resistance gene bla_(DHA-1) was positive in 8 CRKP strains.Ompk35 gene was negative in 6 CRKP strains,Ompk36 gene was negative in 14 CRKP strains.The 19 CRKP strains belonged to 15 different clonotypes by PFGE typing.Conclusions The CRKP isolates in this hospital are highly resistant to a variety of antibacterial agents due to complex mechanisms of resistance,which requires the attention of clinical and infection control departments.