摘要
目的统计院内耐碳青霉烯类肺炎克雷伯菌(CRKP)检出率,分析CRKP的主要耐药基因及毒力基因,了解其感染菌株分子流行病学机制。方法回顾性分析2020-2023年广东省第二中医院(下称该院)CRKP检出率,并收集该院2022年7-12月共计84株CRKP,统计菌株临床资料,PCR扩增相应耐药基因及毒力基因,改良碳青霉烯灭活(mCIM)试验检测碳青霉烯酶。结果2020-2023年该院年CRKP检出率较高,均>46.00%;收集2022年7-12月临床分离84例非重复CRKP菌株,呼吸道来源样本最多,占55.95%,患者以针灸康复科为主,占34.52%;药敏试验显示对多种头孢类及超广谱β内酰胺类药物高度耐药,仅对替加环素及多黏菌素E呈现较高敏感性;mCIM试验阳性率为84.52%(71/84),其余15.48%结果为中性,未能判断是否产碳青霉烯酶。73株检出携带碳青霉烯酶基因,占86.90%,共涉及4种基因型,blaKPC、blaNDM、blaIMP、blaOXA-48的检出率分别为83.33%、2.38%、1.19%、1.19%;其中1株同时携带blaKPC及blaNDM基因,同时检出多种β内酰胺酶,blaSHV、blaTEM、blaCTX-M-9、blaCTX-M-1的检出率分别为96.43%、78.57%、64.29%、2.38%,5种毒力基因blaiucA、blarmpA2、blairoB、blapeg-334、blarmpA检出率分别为42.86%、41.67%、27.38%、3.57%、2.38%;同时携带3种及以上毒力基因的菌株占比为17.85%(15/84)。结论该院CRKP检出率较高,耐药情况严峻,耐药基因以肺炎克雷伯菌碳青霉烯酶(KPC)为主;出现较高比例的耐碳青霉烯类高毒力肺炎克雷伯菌(CR-hvKP)菌株,感染防控情况不容乐观。应进一步加强院内感控措施,科学合理规范用药。
Objective To analyze the detection rate of carbapenem-resistant Klebsiella pneumoniae(CRKP)in Guangdong Provincial Second Hospital of Traditional Chinese Medicine(the hospital)and analyze the main drug resistance genes and virulence genes of CRKP,so as to understand the molecular epidemiological mechanism of its infection strains.Methods The detection rate of CRKP infection in the hospital from 2020 to 2023 was retrospectively analyzed,and a total of 84 strains of CRKP were collected from July to December 2022 in the hospital.The clinical data of the strains were collected,and the corresponding drug resistance genes and virulence genes were amplified by PCR.The modified carbapenem inactivation method(mCIM)was uesd to detect carbapenemase.Results The detection rates of CRKP in the Guangdong Provincial Second Hospital of Traditional Chinese Medicine from 2020 to 2023 were relatively high,and were higher than 46.00%.84 non-repeated CRKP strains were collected from July to December of 2022,and most samples were from respiratory tract,accounting for 55.95%.The patients were mainly from acupuncture and rehabilitation departments,accounting for 34.52%.Drug sensitivity tests showed that CRKP was highly resistant to various cephalosporin and extended spectrum beta lactam drugs,and only showed high sensitivity to tigecycline and polymyxin.The positive rate of mCIM test was 84.52%(71/84),and the other 15.48%results were neutral,which failed to determine whether they produced carbapenemase.A total of 73 strains were detected with carbapenemase gene,accounting for 86.90%,involving 4 genotypes.The detection rates of blaKPC,blaNDM,blaIMP,and blaOXA-48 were 83.33%,2.38%,1.19%,and 1.19%,respectively.One of them carried both blaKPC and blaNDM genes,and multipleβ-lactamases were detected.The detection rates of blaSHV,blaTEM,blaCTX-M-9,and blaCTX-M-1 were 96.43%,78.57%,64.29%,and 2.38%,respectively.The detection rates of five virulence genes,blaiucA,blarmpA2,blairoB,blapeg-334,and blarmpA,were 42.86%,41.67%,27.38%,3.57%,and 2.38%,respectively.The proportion of strains carrying three or more virulence genes was 17.85%(15/84).Conclusion The detection rate of CRKP in the hospital is relatively high,and the drug resistance situation is serious,with Klebsiella pneumoniae carbapenemase(KPC)as the main drug resistance gene.A high proportion of Carbapenem-resistant hypervirulent Klebsiella pneumoniae(CR-hvKp)strains is found,and the infection prevention and control situation is not optimistic.It is necessary to further strengthen the hospital infection control measures and standardize the scientific and reasonable drug use.
作者
李冉
梁玉宜
苏歆
麦东媚
谭俊青
LI Ran;LIANG Yuyi;SU Xin;MAI Dongmei;TAN Junqing(Department of Clinical Laboratory,Guangdong Provincial Second Hospital of Traditional Chinese Medicine,Guangzhou,Guangdong 510095,China;Department of Cliical Laboratory,Guangzhou Nanfang College,Guangzhou,Guangdong 510900,China)
出处
《国际检验医学杂志》
CAS
2024年第22期2773-2778,共6页
International Journal of Laboratory Medicine
基金
广东省中医药局科研项目(20232006)
广东省第二中医院科研创新基金项目(SEZYY2023A13)。
关键词
耐碳青霉烯类肺炎克雷伯菌
耐药基因
毒力基因
分子流行病学
carbapenem-resistant Klebsiella pneumoniae
drug resistance gene
virulence gene
molecular epidemiology
