摘要
目的了解黏菌素耐药的肺炎克雷伯菌耐药特点、临床分布、耐药性表型及基因型,并对菌株进行同源性分析。方法收集2021年1月-2021年12月上海交通大学医学院附属瑞金医院临床分离的黏菌素耐药肺炎克雷伯菌共17株,使用微生物质谱检测系统(MOLDI-TOF MS)进行菌株鉴定,Vitek-2 Compact全自动微生物分析仪进行药敏试验,肉汤稀释法确认黏菌素敏感性,对菌株携带的耐药基因型进行PCR扩增和序列分析,分析菌株之间的同源性。结果17株黏菌素耐药的肺炎克雷伯菌菌株中,血液中分离率最高(4株占23.5%),科室分布以ICU为主(11株占64.7%);黏菌素耐药的肺炎克雷伯菌对β-内酰胺酶抑制剂复合制剂、头孢吡肟、环丙沙星、左氧氟沙星耐药率达100%;均携带bla_(SHV)和bla_(TEM),未检出mcr基因;其中16株(94.1%)多位点序列分型(MLST)为ST-11型;17例分离出黏菌素耐药肺炎克雷伯菌患者均合并多种基础疾病,13例(76.5%)为男性,年龄(37~96)岁,住院天数(33~146)天,9例(52.9%)死亡,4例(23.5%)检出前未接受任何黏菌素相关治疗;系统进化树显示不同部位分离的15株黏菌素耐药肺炎克雷伯菌在进化关系上具有同源性。结论黏菌素耐药肺炎克雷伯菌为广泛耐药菌株,大多携带多种耐药基因,治疗难度大,需引起临床重视,加强耐药菌株防控,合理选用抗菌药物。
OBJECTIVE To understand the drug resistant characteristics,clinical distribution,drug resistance phe-notypes and genotypes of the polymyxin-resistant Klebsiella pneumoniae strains.METHODS Totally 17 strains of polymyxin-resistant K.pneumoniae were isolated from Ruijin Hospital Affiliated to Shanghai Jiao Tong Universi-ty from Jan 2021 to Dec 2021.The strains were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF MS),the drug susceptibility testing was carried out by using Vitek-2 Compact automatic microorganism analyzer,the susceptibility to polymyxin was confirmed by broth dilution method,the drug resistance genotypes that were carried by the strains were amplified by PCR,the sequences were analyzed,and the homology among the strains was observed.RESULTS Among the 17 strains of polymyxin-re-sistant K.pneumoniae,4(23.5%)were isolated from blood,and 11(64.7%)were isolated from ICU.The drug resistance rates of the polymyxin-resistant K.pneumoniae strains toβ-lactamse inhibitor compounds,cefepime,ciprofloxacin and levofloxacin were 100%.All of the strains carried with blaSHV and blaTEM,mcr gene was not detected.Multilocus sequence typing(MLST)showed that 16(94.1%)strains were ST-11 type.Totally 17 patients from whom the polymyxin-resistant K.pneumoniae strains were isolated were complicated with mul-tiple underlying diseases,13 of 17(76.5%)were male,the age ranged between 37 and 96 years old,the length of hospital stay ranged between 33 and 146 days.9(52.9%)cases died,and 4(23.5%)cases did not receive any colistin-related therapy.The phylogenetic tree showed that there was homology among the 15 strains of polymyx-in-resistant K.pneumoniae isolated from different sites.CONCLUSION The polymyxin-resistant K.pneumoniae strains are pandrug-resistant strains,most of which carry with multiple drug resistance genes,posing great diffi-culties to treatment.It is necessary for the hospital to attach great importance,strengthen prevention and control of drug-resistant strains and reasonably use antibiotics.
作者
萧晨路
韩立中
杨之涛
徐玉敏
倪语星
石大可
XIAO Chen-lu;HAN Li-zhong;YANG Zhi-tao;XU Yu-min;NI Yu-xing;SHI Da-ke(Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第1期1-6,共6页
Chinese Journal of Nosocomiology
基金
上海市卫生健康委科研项目(SHD22020203)。
关键词
黏菌素耐药
肺炎克雷伯菌
基因组学
耐药基因
同源性
Polymyxin-resistant
Klebsiella pneumoniae
Genomics
Drug resistance gene
Homology
