目的 检测临床碳青霉烯耐药肺炎克雷伯菌(carbapenemresistant Klebsiella pneumoniae,CRKP)感染的耐药基因,为治疗和防控提供依据。方法 采用回顾性调查方法,收集2017-08至2020-03分离自武警四川总队医院13个科室的32株CRKP,用Microscan.Walk Away96全自动细菌鉴定药敏分析仪进行常规药敏试验,改良碳青霉烯灭活试验(mCIM)联合酶抑制剂增强试验判断其产金属β-内酰胺酶和丝氨酸碳青霉烯酶的情况。Gene-Xpert Carba-ⅩⅤⅠR2全自动病原体快速检测系统检测耐药基因。结果 药敏结果显示我院CRKP对碳青霉烯类、头孢类、头霉素类、单环类、喹诺酮类、氨基糖苷类等抗菌药物均表现出较高耐药性。32株CRKP mCIM结果30株阳性;酶抑制剂增强试验结果表明,1株肺炎克雷伯菌产A类丝氨酸酶加B类β-内酰胺酶,其余29株产A类丝氨酸酶;GeneXpert检测耐药基因,30株mCIM试验结果阳性的菌株中1株肺炎克雷伯菌产KPC+NDM,其余29株均产KPC,没有产IMP,VIM,OX-48的菌株。结论 该院CRKP对常用抗菌药物表现出高水平耐药,耐药机制主要为产碳青霉烯酶,耐药基因型主要为KPC型。在没有条件进行基因型分析的基层单位mCIM试验协同酶抑制剂增强试验能够满足临床需要。
Abstract
Objective To detect the drug-resistant gene of Carbapenem-resistant Klebsiella pneumoniae (CRKP) in a hospital,to find out about the prevalence and distribution of the CRKP genes,and to provide data for treatment and prevention of related infections.Methods In this retrospective cohort study,32 strains of CRKP were collected from 13 departments of a general hospital between August 2017 and March 2020.The Microscan Walk Away96 automatic bacterial identification drug sensitivity analyzer was used for routine drug sensitivity tests.The modified carbapenem inactivation method (mCIM) combined with the enzyme inhibitor enhancement test was used to determine the production of the metal β-lactamase and serine cabapenemase.The Gene-Xpert Carba-XVIR2 automatic pathogen rapid detection system was used to detect drug-resistant genes.Results Drug sensitivity tests showed that the strains of CRKP collected from this hospital were highly resistant to carbapenems,cephalosporins,cephamycins,monocyclics,quinolones,and aminoglycosides antibiotics.Thirty of the 32 strains of CRKP were positive.One strain produced class A serine enzyme plus class B β-lactamase while 29 strains produced class A serine enzyme during the enzyme inhibitor enhancement test.One strain produced KPC+NDM,29 strains produced KPC,but no strains produced IMP,VIM or OX-48 from the Gene-Xpert system.Conclusions CRKP strains collected from this hospital are highly resistant to routinely used antibiotics.The main drug-resistant genotype is KPC type and the main mechanism of action is through carbapenemase production.In hospitals that are incapable of genotype analysis,mCIM can be combined with enzyme inhibitor enhancement tests to meet the clinical needs.
关键词
耐碳青霉烯类肺炎克雷伯菌 /
耐药基因 /
改良碳青霉烯灭活试验 /
酶抑制剂增强实验 /
GeneXpert
Key words
Carbapenem-resistant Klebsiella pneumoniae /
drug-resistant genes /
modified carbapenem inactivation method /
enzyme inhibitor enhancement test /
GeneXpert
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