摘要
目的了解河北医科大学第二医院2015—2017年耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)变迁及流行特征,并进行流行病学分析。方法采用Vitek 2-Compact进行细菌鉴定和药物敏感试验测定,使用Whonet 5.6软件及SPSS 5.0进行数据统计分析,PCR扩增碳青霉烯酶基因blaKPC-2和blaNDM-1;对有流行病学意义的菌株进行多位点序列分型(MLST),目的产物经基因测序和BLAST网上比对确定其基因型。结果 2015—2017年共检出肺炎克雷伯菌非重复菌株4076株。其中,CRKP 831株,占比为20.4%,CRKP主要来源为痰、尿、血,以腹腔引流液耐碳青霉烯肺炎克雷伯菌检出率最高,为22.4%~55.5%;3年间其对亚胺培南耐药率分别为19.3%、24.2%和22.4%,美罗培南耐药率为18.5%、23.1%和21.2%。CRKP对所测试全部抗菌药物耐药率均显著高于碳青霉烯类敏感肺炎克雷伯菌(CSKP)。氨基糖苷类、复方磺胺甲噁唑、头孢替坦对CRKP相对敏感,其他抗菌药物耐药率均高于90%,CS-KP对所测试全部抗菌药物耐药率均低于40%;2016年神经外科耐碳青霉烯肺炎克雷伯菌检出率由2015年3%上升至8%,集中在重症监护室(ICU),耐碳青霉烯酶基因型均为blaKPC-2型,选取神经外科ICU 10d内分离的5株CRKP进行MLST分型,均属于STll型。结论 3年间我院肺炎克雷伯菌耐药情况的变化及2016年在神经外科ICU病房出现的克隆传播,提示我们需采取有效的医院感染防控措施,进一步规范控制抗菌药物使用。
Objective To investigate the resistance surveillance and epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae（CRKP） isolated from the patients in the Second Hospital of Hebei Medical University between January 2015 to December 2017, and to perform homologous analysis. Methods Vitek2-Compact was used for bacterial identification and drug susceptibility testing. Statistical analysis was performed using Whonet 5.6 and SPSS 5.0. The carbopenemase gene KPC-2 and NDM-1 were amplified by PCR in suspected pandemic strains. Five strains were subjected to multilocus sequence typing （MLST）. The target product was genotyped by gene sequencing and online comparisons using BLAST. Results From 2015 to 2017, a total of 4,076 non-replicating Klebsiella pneumoniae strains were detected, of which 831 were resistant to carbapenem-resistant Klebsiella pneumoniae, accounting for 20.4% of the total strains. The major sources of CRKP were sputum, urine, and blood. The highest detection rate of carbapenem-resistant Klebsiella pneumoniae was from 22.4% to 55.5% in peritoneal drainage fluid. The resistant rates to imipenem were 19.3%, 24.2%, and 22.4% respectively in the three years. The resistant rate to meropenem was high. The rates were 18.5%, 23.1%, and 21.2%. The resistant rates of the carbapenem-resistant Klebsiella pneumoniae （CRKP） to all antibacterial agents tested were significantly higher than those of carbapenem-sensitive Klebsiella pneumoniae （CSKP）. CRKP were relatively sensitive to aminoglycosides, cotrimoxazole, and cefotetan, and the resistance rates to other antimicrobial agents were all higher than 90%. The resistant rates of CSKP to all tested antimierobial agents were all lower than 40%. The detection rate of surgical carbapenem-resistant Klebsiella pneumoniae increased from 3% in 2015 to 8%, mainly distributing in the ICU wards. The carbapenem-resistant genotypes were all KPC-2 types, which were selected within 10 days from neurosurgery ICU. The five CRKPs were MLST typed and all belonged to type STll. Conclusion The change of Klebsiellapneumoniae resistance in our hospital during the past three years and the clone transmission in the neurosurgery ICU ward in 2016 prompted us to take effective prevention against nosocomial infections and control measures to further regulate the use of antimicrobial drugs.
作者
李继红
时东彦
李媛媛
范士英
孙倩
张琳
Li Ji-hong;Shi Dong-yan;Li Yuan-yuan;Fan Shi-ying;Sun Qian;Zhang Lin(The Second Hosipital of Hebei Medical University, Shijiazhuang 050000;Hebei Medical University, Shijiazhuang 050000)
出处
《中国抗生素杂志》
CAS
CSCD
2018年第5期572-576,共5页
Chinese Journal of Antibiotics
基金
河北省科技厅指导性计划:河北省血流感染病原菌耐药监测及价值评估(No.152777238)
关键词
肺炎克雷伯菌
耐药监测
碳青霉烯酶
同源性
Klebsiellapneumoniae
Bacterial resistance surveillance
Carbapenemase resistance
Homology
