肺炎克雷伯菌喹诺酮类药物耐药表型与PMQR基因携带相关性研究

Correlation between quinolones resistance phenotypes of Klebsiella pneumoniae and PMQR genes

  • 摘要: 目的 探讨肺炎克雷伯菌喹诺酮类药物耐药表型与质粒介导喹诺酮类耐药基因(PMQR)携带之间的关系,为控制多药耐药肺炎克雷伯菌流行提供理论依据。方法 收集医院临床2014年1月-2015年12月分离的90株肺炎克雷伯菌,其中30株对环丙沙星敏感,20株中介,40株耐药; PCR检测PMQR基因及插入序列ISCR1,对ISCR1阳性菌株采用PCR-mapping检测插入序列下游PMQR基因携带情况,通过DNA测序确定。结果 30株敏感的肺炎克雷伯菌株中qnrA基因阳性8株(26.67%),未检出可移动元件; 20株中介的肺炎克雷伯菌中qnrA 17株(85.00%),qnrB 7株(35.00%),qnrS 5株(25.00%),acc(6')-Ib-cr基因11株(55.00%); ISCR1基因阳性15株(75.00%),PCR-mapping结果显示,ISCR1-qnrA阳性14株(70.00%); ISCR1-qnrBISCR1-qnrS分别检出6株(30.0%)和5株(25.00%); ISCR1-acc(6')-Ib-cr检出4株(20.00%); 40株耐药的多药耐药肺炎克雷伯菌中,qnrA共33株(82.50%),qnrB共12株(30.00%),qnrS共16株(40.00%),acc(6')-Ib-cr28株(70.00%); ISCR1基因阳性菌株30株(75.00%),ISCR1-qnrA1阳性菌株30株,阳性率为75.00%; ISCR1-qnrB4ISCR1-qnrS1阳性率分别为37.50%和30.00%。结论 喹诺酮类中介的肺炎克雷伯菌PMQR基因携带率不低于耐药肺炎克雷伯菌,且其具备通过可移动元件进行传播的能力,因此在对这部分菌株进行多药耐药预防控制时不宜忽视。

     

    Abstract: OBJECTIVE To explore the correlation between the quinolones resistance phenotypes of Klebsiella pneumoniae and PMQR genes so as to provide theoretical basis for control of prevalence of multidrug-resistant Klebsiella pneumoniae . METHODS A total of 90 clinical K.pneumoniae isolates were collected from Jan 2014 to Dec 2015, including 30 strains susceptible to ciprofloxacin, 20 strains intermediate, and 40 strains resistant.The PMQR genes and insert sequence ISCR1 were detected by using PCR, the PMQR genes in the insert sequence downstream of the ISCR1-positive strains were detected by means of PCR-mapping, and all of the PCR products were determined through DNA sequencing. RESULTS Of the 30 strains of K.pneumoniae susceptible to ciprofloxacin, 8 (26.67%) were tested positive for qnrA gene, and the mobile elements were not detected.Of the 20 strains of K.pneumoniae intermediate to ciprofloxacin, 17 (85.00%) strains were positive for qnrA, 7 (35.00%) strains were positive for qnrB, 5 (25.00%) strains were positive for qnrS, and 11 (55.00%) strains were positive for acc(6')-Ib-cr gene; totally 15 (75.00%) strains were positive for ISCR1.The results of PCR-mapping showed that the ISCR1-qnrA was detected positive in 14 (70.00%) strains, ISCR1-qnrB was detected positive in 6 (30.0%) strains, ISCR1-qnrS was detected positive in 5 (25.00%) strains, and ISCR1-acc(6')-Ib-cr was detected positive in 4 (20.00%) strains.Among the 40 strains of multidrug-resistant K.pneumoniae , 33 (82.50%) strains were tested positive for qnrA, 12 (30.00%) strains were tested positive for qnrB, 16 (40.00%) strains were tested positive for qnrS, and 28 (70.00%) strains were tested positive for acc(6')-Ib-cr 28. Totally 30 (75.00%) strains were tested positive for ISCRI gene, and the 30 strains were tested positive for ISCR1-qnrA1, with the positive rate 75.00%; the positive rates of ISCR1-qnrB4 and ISCR1-qnrS1 were 37.50% and 30.00%, respectively. CONCLUSION The carrier rate of the PMQR genes in the quinolones-intermediate K.pneumoniae strains is not as low as that in the quinolones-resistant K.pneumoniae strains, the strains can transmit through the mobile elements, therefore, it is necessary to pay attention to the control of the multidrug-resistant strains.

     

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