2014-2018年长沙医学院第一附属医院临床分离382株高毒肺炎克雷伯菌的耐药基因分析
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摘要
目的研究高毒力肺炎克雷伯菌(highly virulent Klebsiella pneumoniae,hvKP)的临床分布、耐药基因及耐药性,以指导临床合理使用抗菌药物。方法收集长沙医学院第一附属医院2014年1月-2018年12月医院连续分离的hvKP。VITEK-2全自动微生物分析仪对382株hvKP及827株经典肺炎克雷伯菌(classic Klebsiella pneumoniae,cKP)进行鉴定及药敏试验。PCR法检测ESBLs基因,产物测序,BLAST软件比对分析。结果 (1)经统计发现,2014-2018年该院临床感染hvKP的总标本量、痰液标本量、血液标本量、尿液标本量呈逐年递减趋势(P<0.01);(2)hvKP菌株对实验常用抗菌药物具有较高敏感性,耐药率仅为0～11.3%,未发现亚胺培南耐药的菌株,且hvKP较cKP具有更高的敏感性,差异有统计学意义(P<0.01);(3)hvKP的多重耐药率较低,且hvKP和cKP菌株在不同耐药模式下的耐药率差异有统计学意义(P<0.01);(4)在耐药基因检测中:hvKP检出率最高的是blaTEM,为363株(95.0%),cKP检出率最高的是blaCTX-M,为740株(89.5%)。同时发现在hvKP中blaSHV+blaCTX-M+blaTEM为13株(3.4%),而在cKP中未检测出有此种基因型的菌株;(5)hvpk和cKP在临床上常见的3种ESBLs基因bla TEM、blaSHV、blaCTX-M在不同的耐药模式下均差异有统计学意义(P<0.01)。结论尽管hvKP菌株对目前常用抗菌药物具有较高的敏感性,但是高产ESBLs菌株的出现应该引起临床高度重视。
Objective To study the clinical distribution, drug resistance genes and drug resistance analysis of hypervirulent Klebsiella pneumoniae(highly virulent Klebsiella pneumoniae, HvKP) in order to guide the rational use of antibiotics in clinic.Methods Klebsiella pneumoniae isolated continuously from hospitals or communities were collected in the First Affiliated Hospital of Changsha Medical College from January 2014 to December 2018, confirming it by drawing test and Bacillin gene test. VITEK-2 automatic microbial analyzer was used to identify and test the susceptibility of hvKP and classical Klebsiella pneumoniae(cKP). PCR method was used to detect ESBLs gene, product sequencing, BLAST software comparative analysis.Results(1) It was found that the total samples, sputum, blood and urine samples of clinical infection in the hospital showed a significant decreasing trend from 2014 to 2018(P<0.01).(2) hvKP strains had high sensitivity to commonly used antimicrobial agents. The drug resistance rate was 0-11.3%.no imipenem resistant strain was found. The sensitivity of hvKP was higher than that of cKP, and the difference was statistically significant(P<0.01).(3) The multidrug resistance rate of hvKP was low,at the same time, it was found that there was significant difference in drug resistance rate between hvKP and cKP strains under different drug resistance patterns(P<0.01).(4) In the detection of drug resistance genes: the highest detection rate of hvKP was blaTEM, 363 strains(95.0%). the highest detection rate of c KP was blaCTXM,740 strains(89.5%). At the same time,blaSHV+blaCTXM+blaTEMwas found to be 13 strains(3.4%) in hvKP, but no such genotype was detected in cKP.(5) Three common ESBLs gene blaTEM, blaSHV, blaCTXM, hvKP and cKP, have four resistance, three resistance and double resistance to cephalosporins, aminoglycosides, fluoroquinolones in different drug resistant patterns. The resistance rate of carbapenomycin was significantly different(P<0.01). Conclusion Although hvKP strains are highly susceptible to commonly used antibiotics,the emergence of ESBLs-producing strains should be highly valued in clinic.
Objective To study the clinical distribution, drug resistance genes and drug resistance analysis of hypervirulent Klebsiella pneumoniae(highly virulent Klebsiella pneumoniae, HvKP) in order to guide the rational use of antibiotics in clinic.Methods Klebsiella pneumoniae isolated continuously from hospitals or communities were collected in the First Affiliated Hospital of Changsha Medical College from January 2014 to December 2018, confirming it by drawing test and Bacillin gene test. VITEK-2 automatic microbial analyzer was used to identify and test the susceptibility of hvKP and classical Klebsiella pneumoniae(cKP). PCR method was used to detect ESBLs gene, product sequencing, BLAST software comparative analysis.Results(1) It was found that the total samples, sputum, blood and urine samples of clinical infection in the hospital showed a significant decreasing trend from 2014 to 2018(P<0.01).(2) hvKP strains had high sensitivity to commonly used antimicrobial agents. The drug resistance rate was 0-11.3%.no imipenem resistant strain was found. The sensitivity of hvKP was higher than that of cKP, and the difference was statistically significant(P<0.01).(3) The multidrug resistance rate of hvKP was low,at the same time, it was found that there was significant difference in drug resistance rate between hvKP and cKP strains under different drug resistance patterns(P<0.01).(4) In the detection of drug resistance genes: the highest detection rate of hvKP was blaTEM, 363 strains(95.0%). the highest detection rate of c KP was blaCTXM,740 strains(89.5%). At the same time,blaSHV+blaCTXM+blaTEMwas found to be 13 strains(3.4%) in hvKP, but no such genotype was detected in cKP.(5) Three common ESBLs gene blaTEM, blaSHV, blaCTXM, hvKP and cKP, have four resistance, three resistance and double resistance to cephalosporins, aminoglycosides, fluoroquinolones in different drug resistant patterns. The resistance rate of carbapenomycin was significantly different(P<0.01). Conclusion Although hvKP strains are highly susceptible to commonly used antibiotics,the emergence of ESBLs-producing strains should be highly valued in clinic.
引文
[1]周岩,多丽波.肺炎克雷伯菌外膜蛋白与耐药性关系的研究进展[J].国际检验医学,2018,39(15):1890-1893.
[2]Liu YM,Li BB,Zhang YY,et al.Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China[J].Antimicrobial Agents and Chemotherapy,2014,58(9):5379-5385.
[3]Zhang YW,Zhao CJ,Wang Q,et al.High prevalence of hypervirulent klebsiella pneumoniae infection in China:geographic distribution,clinical characteristics,and antimicrobial resistance[J].Antimicrobial Agents and Chemotherapy,2016,60(10):6115-6120.
[4]翟俊斌,贾佳,程莉,等.产KPC-2肺炎克雷伯菌的MLST和wzi分型分析[J].临床检验杂志,2018,36(9):660-662,666.
[5]周永年,戎建荣,杨云,等.产超广谱β-内酰胺酶肺炎克雷伯菌耐药表型和基因特征分析[J].中国药物与临床,2017,18(8):1230-1231.
[6]沈平华,仉英,蒋晓飞.肺炎克雷伯菌携带碳青霉烯酶KPC-2基因环境多态性研究[J].中国感染与化疗杂志,2016,16(6):680-684.
[7]黄阶胜,陆丹倩,顾向明,等.产超广谱β-内酰胺酶肺炎克雷伯菌的检测及耐药性变迁[J].实用预防医学,2016,23(9):1142-1143.
[8]李花,王倩.肝脓肿肺炎克雷伯菌血清分型及毒力基因研究[J].临床检验杂志,2018,36(7):493-495.
[9]胡仁静,汤怡颖,胡锡池,等.肝脓肿相关肺炎克雷伯菌毒力基因检测及同源性分析[J].临床检验杂志,2018,36(4):263-266.
[10]王海,汪宏良,程攀.产超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌的耐药性分析[J].实验与检验医学,2015,33(5):653-655.
[11]梁丽霞,岑丽莲,赖汉瑜,等.311株肺炎克雷伯菌感染分布及耐药分析[J].实验与检验医学,2016,34(3):375-376.
[12]魏丹丹,李喜红,王莲慧,等.血液分离高黏液表型肺炎克雷伯菌的毒力基因检测及生物膜形成测定[J].中国感染与化疗杂志,2016,28(5):622-626.
[13]杜芳玲,梅艳芳,万腊根,等.高黏液型肺炎克雷伯菌荚膜血清分型及碳青霉烯类耐药机制研究[J].中国感染与化疗杂志,2018,18(3):278-285.
[2]Liu YM,Li BB,Zhang YY,et al.Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China[J].Antimicrobial Agents and Chemotherapy,2014,58(9):5379-5385.
[3]Zhang YW,Zhao CJ,Wang Q,et al.High prevalence of hypervirulent klebsiella pneumoniae infection in China:geographic distribution,clinical characteristics,and antimicrobial resistance[J].Antimicrobial Agents and Chemotherapy,2016,60(10):6115-6120.
[4]翟俊斌,贾佳,程莉,等.产KPC-2肺炎克雷伯菌的MLST和wzi分型分析[J].临床检验杂志,2018,36(9):660-662,666.
[5]周永年,戎建荣,杨云,等.产超广谱β-内酰胺酶肺炎克雷伯菌耐药表型和基因特征分析[J].中国药物与临床,2017,18(8):1230-1231.
[6]沈平华,仉英,蒋晓飞.肺炎克雷伯菌携带碳青霉烯酶KPC-2基因环境多态性研究[J].中国感染与化疗杂志,2016,16(6):680-684.
[7]黄阶胜,陆丹倩,顾向明,等.产超广谱β-内酰胺酶肺炎克雷伯菌的检测及耐药性变迁[J].实用预防医学,2016,23(9):1142-1143.
[8]李花,王倩.肝脓肿肺炎克雷伯菌血清分型及毒力基因研究[J].临床检验杂志,2018,36(7):493-495.
[9]胡仁静,汤怡颖,胡锡池,等.肝脓肿相关肺炎克雷伯菌毒力基因检测及同源性分析[J].临床检验杂志,2018,36(4):263-266.
[10]王海,汪宏良,程攀.产超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌的耐药性分析[J].实验与检验医学,2015,33(5):653-655.
[11]梁丽霞,岑丽莲,赖汉瑜,等.311株肺炎克雷伯菌感染分布及耐药分析[J].实验与检验医学,2016,34(3):375-376.
[12]魏丹丹,李喜红,王莲慧,等.血液分离高黏液表型肺炎克雷伯菌的毒力基因检测及生物膜形成测定[J].中国感染与化疗杂志,2016,28(5):622-626.
[13]杜芳玲,梅艳芳,万腊根,等.高黏液型肺炎克雷伯菌荚膜血清分型及碳青霉烯类耐药机制研究[J].中国感染与化疗杂志,2018,18(3):278-285.