青岛市区5家医院耐碳青霉烯类肺炎克雷伯杆菌耐药基因检测及分析

来源 :中华危重病急救医学 | 被引量 : 0次 | 上传用户:j621212
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目的:通过对耐碳青霉烯类肺炎克雷伯杆菌(CRKP)的碳青霉烯酶表型的筛查及耐药基因检测,明确青岛市区该细菌耐药基因的分布及构成,为临床上合理应用抗菌药物治疗提供依据。方法:收集2016年10月至2019年9月青岛市区5家三甲医院临床分离出的非重复CRKP共54株,采用琼脂稀释法或纸片扩散法(K-B法)进行常用抗菌药物的药敏试验;应用改良Hodge试验进行碳青霉烯酶表型筛查;采用聚合酶链反应(PCR)扩增n blaKPC-2、n blaNDM-1、n blaOXA-48、n blaIMP、n blaVIM目的基因,扩增产物进行琼脂糖凝胶电泳。n 结果:药敏试验显示,CRKP对阿米卡星耐药率最低(35.2%),其次为复方新诺明(53.7%)、庆大霉素(55.6%)、左氧氟沙星(75.9%)、亚胺培南/西司他丁(88.9%),哌拉西林/他唑巴坦、美罗培南、头孢噻肟、头孢哌酮/舒巴坦钠的耐药率均高于90%。改良Hodge试验阳性菌株有43株(阳性率为79.63%),阴性菌株为11株。PCR耐药基因检测共检出带有碳青霉烯酶耐药基因的菌株40株,目的耐药基因检出率为74.07%。其中35株携带KPC-2基因,7株携带OXA-48基因,4株携带NDM-1基因,1株携带IMP基因,其中携带有OXA-48基因的菌株均同时携带KPC-2基因,未检测出携带VIM基因的菌株,剩余14株未检测出目标碳青霉烯酶基因。结论:青岛市区5家医院CRKP携带的产碳青霉烯酶基因主要为KPC-2,其次为OXA-48及NDM-1。“,”Objective:To clarify the distribution and composition of drug-resistant genes of carbapenem-resistant n Klebsiella pneumoniae (CRKP) in Qingdao City and to provide rationale for clinical application of antibacterial treatment by screening for carbapenemase phenotype and detecting resistance genes of CRKP.n Methods:Fifty-four clinically isolated non-repeating CRKP from five Third Grade & Class A Hospitals in Qingdao City from October 2016 to September 2019 were collected. Kirby-Bauer method was used for drug sensitivity tests of commonly used antibacterial drugs; modified Hodge test was used for carbapenemase phenotypic screening; and polymerase chain reaction (PCR) was used to amplify n blaKPC-2, n blaNDM-1, n blaOXA-48, n blaIMP, n blaVIM target genes. The amplified products were subjected to agarose gel electrophoresis.n Results:Drug susceptibility tests showed that CRKP had the lowest resistance rate to amikacin (35.2%), followed by compound sinomine (53.7%), gentamicin (55.6%), levofloxacin (75.9%), and imipenem-cilastatin (88.9%); piperacillin-tazobactam, meropenem, cefotaxime, and cefoperazone-sulbactam were all higher than 90%. There were 43 positive strains in the modified Hodge test (the positive rate was 79.63%) and 11 negative strains. A total of 40 strains with carbapenemase resistance were detected by PCR resistance gene detection. The detection rate of target drug-resistant genes was 74.07%. Among them, 35 strains carry the KPC-2 gene, 7 strains carry the OXA-48 gene, 4 strains carry the NDM-1 gene, and 1 strain carries the IMP gene. All strains carrying the OXA-48 gene also carried the KPC-2 gene, which was not detected. Strains carrying the VIM gene were identified, and the remaining 14 strains did not detect the target carbapenem gene.Conclusion:The carbapenem-producing genes carried by CRKP in five hospitals in Qingdao City are mainly KPC-2, followed by OXA-48 and NDM-1.
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