常熟地区耐碳青霉烯类肺炎克雷伯菌耐药机制及同源性分析
摘要
目的分析常熟地区耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药性和分子流行特征。方法收集2017年1月至12月常熟地区分离的34株CRKP菌株,使用Vitek 2系统进行细菌鉴定及药敏试验,PCR筛选碳青霉烯酶基因并测序,质粒接合转移实验验证耐药质粒的可转移性,脉冲场凝胶电泳(PFGE)分析菌株同源性。结果 34株CRKP对亚胺培南、美罗培南的耐药率均为100%,有33株检测到耐药基因,其中30株携带bla_(KPC-2)基因、4株携带bla_(NDM-1)基因、1株携带bla_(IMP-4)基因(有2株同时携带bla_(KPC-2)和bla_(NDM-1)基因)。质粒接合试验成功获得25株bla_(KPC-2)阳性质粒。同源性分析显示共有11种型别,其中A型15株,B型9株,C型有2株,其余型各1株。结论常熟地区的CRKP以携带bla_(KPC-2)质粒为主,菌株克隆以A型和B型为主,存在小范围的克隆性传播。
引文
[1]全国细菌耐药监测网. 2016年全国细菌耐药监测报告[OL].[2017-12-20].http://www.carss.cn/Report/Details/403.
[2]张霞,王莹超,眭阳,等.产碳青霉烯酶肠杆菌科细菌合并多黏菌素耐药基因mcr-1的研究[J].中华临床感染病杂志,2016,9(5):444-447.
[3]宁长秀,胡龙华,汪红,等.南昌4家教学医院碳青霉烯类耐药肺炎克雷伯菌耐药机制及同源性分析[J].临床检验杂志,2014,32(4):306-310.
[4]高源,张砺,李马超,等.肺炎克雷伯菌脉冲场凝胶电泳及多位点序列分型技术的联合应用[J].中华流行病学杂志,2010,31(7):786-790.
[5]Tenover FC,Arbeit RD,Goering RV,et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis:criteria for bacterial strain typing[J].J Clin Microbiol,1995,33(9):2233-2239.
[6]Borer A,Saidel-Odes L,Riesenberg K,et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia[J].Infect Control Hosp Epidemiol,2009,30(10):972-976.
[7]Munoz-Price LS,Poirel L,Bonomo RA,et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J].Lancet Infect Dis,2013,13(9):785-796.
[8]Queenan AM,Bush K.Carbapenemases:the versatile beta-lactamases[J].Clin Microbiol Rev,2007,20(3):440-458.
[9]Chen L,Mathema B,Chavda KD,et al. Carbapenemase-producing Klebsiella pneumoniae:molecular and genetic decoding[J]. Trends Microbiol,2014,22(12):686-696.
[10]Yu F,Wang S,Lv J,et al. Coexistence of OXA-48-producing Klebsiella pneumoniae and Escherichia coli in a hospitalized patient returned from Europe to China[J]. Antimicrob Agents Chemother,2017,61(4):pii:e02580-16.
[11]Liu Y,Wan LG,Deng Q,et al. First description of NDM-1-,KPC-2-,VIM-2-and IMP-4-producing Klebsiella pneumoniae strains in a single Chinese teaching hospital[J]. Epidemiol Infect,2015,143(2):376-384.
[12]Wang Y,Cao W,Zhu X,et al. Characterization of a novel Klebsiella pneumoniae sequence type 476 carrying both blaKPC-2and blaIMP-4[J]. Eur J Clin Microbiol Infect Dis,2012,31(8):1867-1872.
[13]Koroglu M,Ozbek A,Demiray T,et al. Investigation of clonal relationships of K.pneumoniae isolates from neonatal intensive care units by PFGE and rep-PCR[J]. J Infect Dev Ctries,2015,9(8):829-836.
[2]张霞,王莹超,眭阳,等.产碳青霉烯酶肠杆菌科细菌合并多黏菌素耐药基因mcr-1的研究[J].中华临床感染病杂志,2016,9(5):444-447.
[3]宁长秀,胡龙华,汪红,等.南昌4家教学医院碳青霉烯类耐药肺炎克雷伯菌耐药机制及同源性分析[J].临床检验杂志,2014,32(4):306-310.
[4]高源,张砺,李马超,等.肺炎克雷伯菌脉冲场凝胶电泳及多位点序列分型技术的联合应用[J].中华流行病学杂志,2010,31(7):786-790.
[5]Tenover FC,Arbeit RD,Goering RV,et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis:criteria for bacterial strain typing[J].J Clin Microbiol,1995,33(9):2233-2239.
[6]Borer A,Saidel-Odes L,Riesenberg K,et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia[J].Infect Control Hosp Epidemiol,2009,30(10):972-976.
[7]Munoz-Price LS,Poirel L,Bonomo RA,et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J].Lancet Infect Dis,2013,13(9):785-796.
[8]Queenan AM,Bush K.Carbapenemases:the versatile beta-lactamases[J].Clin Microbiol Rev,2007,20(3):440-458.
[9]Chen L,Mathema B,Chavda KD,et al. Carbapenemase-producing Klebsiella pneumoniae:molecular and genetic decoding[J]. Trends Microbiol,2014,22(12):686-696.
[10]Yu F,Wang S,Lv J,et al. Coexistence of OXA-48-producing Klebsiella pneumoniae and Escherichia coli in a hospitalized patient returned from Europe to China[J]. Antimicrob Agents Chemother,2017,61(4):pii:e02580-16.
[11]Liu Y,Wan LG,Deng Q,et al. First description of NDM-1-,KPC-2-,VIM-2-and IMP-4-producing Klebsiella pneumoniae strains in a single Chinese teaching hospital[J]. Epidemiol Infect,2015,143(2):376-384.
[12]Wang Y,Cao W,Zhu X,et al. Characterization of a novel Klebsiella pneumoniae sequence type 476 carrying both blaKPC-2and blaIMP-4[J]. Eur J Clin Microbiol Infect Dis,2012,31(8):1867-1872.
[13]Koroglu M,Ozbek A,Demiray T,et al. Investigation of clonal relationships of K.pneumoniae isolates from neonatal intensive care units by PFGE and rep-PCR[J]. J Infect Dev Ctries,2015,9(8):829-836.