肺炎克雷伯菌的敏感性及其质粒介导的耐药基因的分布特点分析

doi:10.3969/j.issn.1671-2587.2020.04.021

临床输血与检验 ›› 2020, Vol. 22 ›› Issue (4): 425-429.DOI: 10.3969/j.issn.1671-2587.2020.04.021

肺炎克雷伯菌的敏感性及其质粒介导的耐药基因的分布特点分析

翟俊斌, 曹小利, 程莉, 周万青, 张之烽, 沈瀚

210008 南京大学医学院附属鼓楼医院检验科

收稿日期:2019-02-27 出版日期:2020-08-20 发布日期:2020-08-12
作者简介:翟俊斌（1992-）, 男, 江苏盐城人, 检验技师, 学士, 主要从事临床检验工作, （E-mail）2547605632@qq.com。

Sensitivity of Klebsiella Pneumoniae to Antibiotics and Its Genetic Distribution of Plasmid Mediated Resistance to Quinilone

ZHAI Jun-bin, CAO Xiao-li, CHENG Li, et al.

Department of Laboratory Medicine, The Drum Tower Hospital of Nanjing University Medical College, Nanjing 210008

Received:2019-02-27 Online:2020-08-20 Published:2020-08-12

摘要/Abstract

摘要： 目的分析肺炎克雷伯菌的敏感性和质粒介导的耐药基因在肺炎克雷伯菌中的分布特点。方法收集我院肺炎克雷伯菌115株, 微量肉汤稀释法测定细菌的敏感性;使用PCR和DNA测序技术检测超广谱ß内酰胺酶、AmpC酶、碳青霉烯酶及16S rRNA甲基化酶的编码基因和喹诺酮耐药基因。根据亚胺培南的MIC, 将菌株分为碳青霉烯不敏感肺炎克雷伯菌（CNSKP）和碳青霉烯敏感肺炎克雷伯菌（CSKP）, 分析上述基因在两组中的分布差异。结果 115株细菌对所测药物的不敏感率在30%以上;DNA分析显示blaCTX-M-14是最主要的blaESBL;oqxAB的流行率最高, 为60.9%, 并且在CSKP中的分布显著高于CNSKP组, 而blaCTX-M、blaTEM和rmtB在CRKP组的分布在CNSKP显著高于CSKP组（P<0.05）。结论应加强抗生素的合理使用和感染控制措施的实施, 以减缓耐药元件的播散, 预防CNSKP的产生。

关键词: 肺炎克雷伯菌, 超广谱ß, 内酰胺酶, 质粒介导喹诺酮类耐药基因, AmpC内酰胺酶, 16S, rRNA甲基化酶

Abstract: Objective To analyze the drug resistance of Klebsiella pneumoniae and its distribution of plasmid mediated resistant genes. Methods A total of 115 K. pneumoniae isolates were collected and the drug susceptibility was determined by microdilution. PCR and DNA sequencing were used to detect the prevalence of extended ß-lactmase, AmpC enzyme, carbapenemase, 16S rRNA methylase encoding genes and the plasmid meidated quinolone resistance loci. The bacteria strains were divided into 2 groups according to the MIC of imipenem, the difference of the genetic distribution was compared. Results Over 30 percent of isolates showed non-sensitivity to antibiotics, and blaCTX-M-14 dominated in the blaESBL. The highest prevalence of oqxAB was noted, accounting for 60.9% and obviously higher in CSKP than in the CRKP. In comparison, the prevalence of blaCTX-M and blaTEM as well as rmtB was higher in CNSKP than that in CSKP（P<0.05）. Conclusion The rational use of antimicrobial agents and the implementation of infection control measures should be emphasized in order to inhibit the occurance of CNSKP by restricting the spread of resistant elements.

Key words: Klebsiella, pneumoniae, ESBL, PMQRs, AmpC, 16, s-RMTase

中图分类号:

R378.98⁺6

翟俊斌, 曹小利, 程莉, 周万青, 张之烽, 沈瀚. 肺炎克雷伯菌的敏感性及其质粒介导的耐药基因的分布特点分析[J]. 临床输血与检验, 2020, 22(4): 425-429.

ZHAI Jun-bin, CAO Xiao-li, CHENG Li, et al.. Sensitivity of Klebsiella Pneumoniae to Antibiotics and Its Genetic Distribution of Plasmid Mediated Resistance to Quinilone[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2020, 22(4): 425-429.

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肺炎克雷伯菌的敏感性及其质粒介导的耐药基因的分布特点分析

Sensitivity of Klebsiella Pneumoniae to Antibiotics and Its Genetic Distribution of Plasmid Mediated Resistance to Quinilone

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