摘要
目的 分析比较医院与社区感染多耐药肺炎克雷伯菌的耐药率、整合子基因盒及分子分型,为临床合理使用抗菌药物提供依据。方法 收集117株多耐药肺炎克雷伯菌,根据病史对菌株进行医院与社区感染分类,统计分析药敏结果;随机纳入医院与社区感染多耐药肺炎克雷伯菌各30株,采用多重PCR检测Ⅰ类、Ⅱ类、Ⅲ类整合酶基因及整合子可变区,进一步对整合子阳性菌株的可变区进行测序分析,利用多位点序列分型(MLST)对菌株进行同源性及遗传相关性研究。结果 医院感染株对临床常用多种抗菌药物(头孢第四代头孢吡肟,氨基糖苷类阿米卡星,喹诺酮类呋喃妥因)的耐药率明显高于社区感染株;医院感染株Ⅰ类整合子阳性率(100%,30/30)高于社区感染株(80%,24/30)(P<0. 05),未检测出Ⅱ类、Ⅲ类整合子;医院感染株基因盒阳性率(70%,21/30,21株均为dfrA12-orf1-aadA2)高于社区感染株(60%,18/30,12株dfrA12-orf1-aadA2、2株aadA2、4株drfA12-orf2);经MLST分析,医院感染株共有5种ST型,社区感染株共有6种ST型(发现1个新的ST型),主要流行克隆均为ST11。结论 多耐药肺炎克雷伯菌医院与社区感染株的耐药率、Ⅰ类整合子阳性率、基因盒阳性率以及ST型均存在一定差异,临床应根据感染性质合理、规范使用抗菌药物。
Objective To investigate the status of integrons,the relations with their carrying antibiotic resistance gene,the status of molecular epidemiology of multi-drug resistance Klebsiella pneumonia(K.pneumoniae)from nosocomial and community infections.Methods In total,117 strains of multi-drug resistance K.pneumonia were collected in Ningbo Medical Center Li Huili Hospital.The class Ⅰ,Ⅱ,Ⅲ integrons and the variable regions of integrons were analyzed by PCR and sequencing.Seven housekeeping genes specific to K.pneumonia were amplified and sequenced.Multilocus sequence typing(MLST)was used to classify the sequence types of K.pneumonia.Results The antibiotic resistance rate of nosocomial infections was signify icantly higher than that of community infections.The integron positive rate(100%,30/30)of multi-drug resistance K.pneumonia from nosocomia infections is significantly higher than the strains(80%,24/30)from community infections(P<0.05),and none strains carried Int Ⅱ and Int Ⅲ.The positive rate of nosocomial infection strains(70%,21/30,21 strains were dfrAV1-0fr1-aadA2)was higher than that of community infection strains(60%,18/30,12 strains were dfrA12-orfl-aadA2,2 strains were aadA2,4 strains were drfAA.2-orfl).According to MLST analysis,there were 5 ST types in hospital-infected strains and 6 ST types in community-infected strains(a new ST type was found),and ST11 was the main prevalent clone.Conclusion There was significant differences in drug resistance,integron positive rate and sequence type between nosocomial and community infection.It is necessary to strengthen the research on drug resistance of nosocomial infection patients and standardize their experiential drug use,control nosocomial infection,and reduce the mortality rate of nosocomial infection.
作者
王瑛
张恩
李霞
WANG Ying;ZHANG En;LI Xia(Pharmacy Department,Ningbo Medical Center Li Huili Hospital,Ningbo,Zhejiang 315040,China;不详)
出处
《中国卫生检验杂志》
CAS
2021年第21期2614-2618,共5页
Chinese Journal of Health Laboratory Technology
基金
宁波市自然科学基金项目(2017A610280)。
关键词
肺炎克雷伯菌
医院与社区感染
耐药性
整合子
多位点序列分型
Klebsiella pneumoniae
Nosocomial and community infection
Drug resistance
Integron
Multilocus sequence typing
