耐亚胺培南肺炎克雷伯菌的耐药机制研究

Drug resistance mechanisms of imipenem-resistant Klebsiella pneumoniae

  • 摘要: 目的 探讨耐亚胺培南肺炎克雷伯菌的流行病学特征和β-内酰胺酶基因型,为临床合理用药和感染控制提供依据。方法 收集2014年2 -11月临床分离25株耐亚胺培南肺炎克雷伯菌,采用VITEK-2微生物系统检测菌株的药物敏感性; 改良Hodge试验检测碳青霉烯酶; PCR检测β-内酰胺酶基因KPC-2、SHV、CTX-M、IMP、VIM、NDM-1、OXA-48; 采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC-PCR) 对菌株进行同源性分析。结果 在检测的18种药物中,哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢唑林、头孢曲松、氨苄西林、厄他培南、亚胺培南、氨曲南的耐药率均为100.0%,磺胺甲噁唑/甲氧苄啶的耐药率最低为32.0%,其次为阿米卡星和妥布要素均为(68.0%); 改良Hodge试验阳性20株(80.0%); 25株菌均检测到SHV基因,20株菌检测到CTX-M基因,15株检测到KPC-2基因,1株菌检测到IMP-4基因,3株菌检测到NDM-1基因,未检测到VIM、OXA-48基因; 25株菌分为6型,为A、B、C、D、E、F,分别有15、5、2、1、1、1株。结论 耐亚胺培南的肺炎克雷伯菌多药耐药严重,产生β-内酰胺酶是菌株对多种药物耐药的主要机制,且菌株存在克隆性传播,3株菌检测到NDM-1基因,应引起相关部门的重视。

     

    Abstract: OBJECTIVE To study the epidemiological characteristics and genotypes of β-lactamase in imipenem-resistant Klebsiella pneumoniae so as to provide guidance for reasonable clinical use of antibiotics and control of infections. METHODS A total of 25 strains of imipenem-resistant K.pneumoniae were collected from Feb 2014 to Nov 2014.The drug susceptibility was tested by microorganism analytical system VITEK-2, the modified Hodge test was carried out to screen carbapenemases of the strains, PCR was used to detect KPC-2, SHV, CTX-M, IMP, VIM, NDM-1, and OXA-48 of β-lactamase genes.The homology of the 25 strains was analyzed by mean of enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). RESULTS Among the 18 antibiotics tested, the drug resistance rates to piperacillin-tazobactam, ampicillin/sulbactam, cefazolin, ceftriaxone, ampicillin, ertapenem, imipenem, and aztreonam were 100.0%; the drug resistance rate to sulfamethoxazole-trimethoprim was the lowest (32.0%), followed by amikacin and tobvamyin toth (68.0%).The modified Hodge test showed that 20 strains(80.0%) were positive; totally 25 strains were tested positive for SHV gene, 20 strains were tested positive for CTX-M gene, 15 strains were tested positive for KPC-2 gene, 1 strain was tested positive for IMP-4 gene, 3 strains were tested positive for NDM-1 gene, and VIM and OXA-48 genes were tested negative.The 25 strains were classified into 6 genotypes, namely as the followsing: A (15 strains), B (5 strains), C (2 strains), D (1 strain), E(1 strain), and F (1 strain). CONCLUSION The imipenem-resistant K.pneumoniae strains are highly multidrug-resistant; the production of the β-lactamase is the leading mechanism for the resistance to multiple antibiotics, and there is a clonal spread in the area, and 3 strains carrying NDM-1 gene, to which great attention should be paid.

     

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