| 贺文芳,周 磊,孟 倩,康蓓佩,杨玉琪,刘家云,郝晓柯,徐修礼.医院肺炎克雷伯菌耐药及分子流行病学特征研究[J].,2020,(22):4234-4238 |
| 医院肺炎克雷伯菌耐药及分子流行病学特征研究 |
| Study on Klebsiella Pneumoniae Resistance and Molecular Epidemiological Characteristics in Hospital |
| 投稿时间：2020-05-27 修订日期：2020-06-23 |
| DOI：10.13241/j.cnki.pmb.2020.22.007 |
| 中文关键词: 肺炎克雷伯菌 耐碳青霉烯类肠杆菌 多位点序列分型 医院感染 |
| 英文关键词: Klebsiella pneumoniae Carbapenem-resistant Enterobacteriaceae Multilocus sequence typing Nosocomial infection |
| 基金项目:国家自然科学基金项目（81601816） |
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| 中文摘要: |
| 摘要 目的：了解医院肺炎克雷伯菌的耐药及分子流行特点，分析其基因同源性，为医院感染控制提供实验室依据。方法：收集2017年10月-2018年12月医院分离的耐碳青霉烯类肺炎克雷伯菌和碳青霉烯类敏感肺炎克雷伯菌，用梅里埃VITEK 2 Compact 全自动微生物分析系统进行细菌鉴定和药敏分析，K-B法药敏予以补充；采用赛沛Xpert?Carba-R试剂盒检测耐碳青霉烯类肺炎克雷伯菌碳青霉烯耐药基因；采用多位点序列分析技术检测菌株7个管家基因型别及其ST型别，使用eBURST软件对ST数据进行亲缘性关系分析。结果：共分离到63株耐碳青霉烯类肺炎克雷伯菌和211株碳青霉烯类敏感肺炎克雷伯菌（随机选取30株作研究）；耐药组对青霉素类、大环内酯类、头孢菌素类、喹诺酮类、含酶抑制剂类、四环素类耐药率显著高于敏感组；63株耐药株中，96.83%（61/63）产KPC酶，1.59%（1/63）产KPC酶和NDM酶，1.59%（1/63）未检测到5种碳青霉烯酶基因；耐碳青霉烯类组获得8个ST型别，包括ST11（54/63，85.71%）、ST15（2/63，3.17%）、ST392（2/63，3.17%）、ST45（1/63，1.59%）、ST147（1/63，1.59%），ST659（1/63，1.59%）、ST3228（1/63，1.59%）、STr1（1/63，1.59%），STr1为新发现型别，属于克隆复合体11；30株碳青霉烯敏感组获得25个ST型别，包括ST35（3/30，10.00%），ST659（3/30，10.00%），ST147（2/30，6.67%），ST485、 ST34、 ST395、ST370、ST2388、ST893、ST11、ST2176、ST221、ST86、ST380、ST65、ST920、ST268、ST25、ST2154、ST2229以及5个新ST型别（STs1,STs2,STs3,STs4,STs5）各1株，分别占3.33%，两组比较，耐药组ST型别集中而敏感组离散，差异明显。结论：医院耐碳青霉烯肺炎克雷伯菌具有基因同源相关性，并呈现水平传播的趋势。 |
| 英文摘要: |
| ABSTRACT Objective: To understand the molecular epidemic characteristics of Klebsiella pneumoniae in hospitals and analyze their genetic homology correlation to provide laboratory basis for nosocomial infection control. Methods: Carbapenem-resistant Klebsiella pneumoniae and Carbapenem-sensitive Klebsiella pneumoniae isolated from October 2017 to December 2018 were collected. Merière VITEK 2 Compact full-automatic microbial analysis system was used for bacterial identification and drug sensitivity analysis, supplemented by K-B method; and Cyper Xpert?Carba-R kit was used to detect carbapenem-resistant genes; Seven-housekeeper genotypes and ST strains of the strains were analyzed using multi-site sequence analysis technology, and the etiological analysis of ST data was performed using eBURST software. Results: A total of 63 strains of carbapenem-resistant Klebsiella pneumoniae and 211 strains of carbapenem-sensitive Klebsiella pneumoniae were collected. Compared with the sensitive group, the drug-resistant rates to penicillins, macrolides, cephalosporins, quinolones, enzyme inhibitors, and tetracyclines of resistant group were significantly higher. Of the 63 resistant strains, 96.83% (61/63) produced KPC enzyme, and 1.59% (1/63) produced KPC enzyme and NDM enzyme, 1.59% (1/63) did not detect 5 carbapenemase genes; the carbapenem-resistant group obtained 8 ST types, including ST11 (54/63, 85.71%), ST15 (2/63, 3.17%), ST392 (2/63, 3.17%), ST45 (1/63, 1.59%), ST147 (1/63, 1.59%), ST659 (1/63, 1.59%), ST3228 (1/63, 1.59%), STr1 (1/63, 1.59%), STr1 was a newly discovered type and belongs to the cloning complex 11; 30 carbapenem-sensitive groups obtained 25 ST types, including ST35 (3/30, 10.00%), ST659 (3/30, 10.00%), ST147 (2/30, 6.67%), ST485, ST34, ST395, ST370, ST2388, ST893, ST11, ST2176, ST221, ST86, ST380, ST65, ST920, ST268, ST25, ST2154, ST2229 and 5 new ST types (STs1, STs 2, STs3, STs4, STs5), accounting for 3.33% repectively. The ST type in the drug-resistant group was concentrated while that of the sensitive group was discrete. Conclusion: Hospital carbapenem-resistant Klebsiella pneumoniae has a gene homology correlation and shows a trend of horizontal transmission. |
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