碳青霉烯酶耐药肺炎克雷伯菌耐药基因分布及与表型相关性分析

doi:10.3969/j.issn.1671-2587.2021.04.020

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (4): 501-506.DOI: 10.3969/j.issn.1671-2587.2021.04.020

碳青霉烯酶耐药肺炎克雷伯菌耐药基因分布及与表型相关性分析

谢强, 谢瑞玉, 徐添天

239001 安徽省滁州市第一人民医院检验科

收稿日期:2021-03-16 发布日期:2021-08-18
作者简介:谢强（1982-）,男,安徽滁州人,主管检验师,硕士,主要从事细菌耐药方面的研究,（E-mail）xieqiang0912@163.com。

Correlation Analysis of Antimicrobial Resistance and Resistance Genes of Carbapenem-resistant Klebsiella Pneumonia

XIE Qiang, XIE Rui-yu, XU Tian-tian

Department of Laboratory Medicine, Chuzhou First Hospital, Chuzhou 239001

Received:2021-03-16 Published:2021-08-18

摘要/Abstract

摘要： 目的通过全基因组测序技术（whole genome sequencing,WGS）分析某三甲医院耐碳青霉烯肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumonia,CRKP）的耐药基因分布及与耐药表型的关系,为临床治疗和防控提供参考。方法收集并鉴定临床分离非重复CRKP 28株。采用VITEK-2 compact全自动微生物鉴定药敏分析仪进行鉴定和药敏试验,使用全基因组测序技术进行测序。结果共检出47种耐药基因。其中碳青霉烯类耐药基因3种,主要为blaKPC-2基因（25株,89.29%）,其次为blaNDM-5基因（2株,7.14%）和blaOXA-48基因（1株,3.57%）;超广谱β-内酰胺酶（exterded spectrumβ-lactamases,ESBLs）耐药基因8种,主要为blaTEM-1、blaSHV-28、blaCTX-M-15和blaOXA-33,检出率分别为89.29%、75.00%、75.00%和67.86%;氨基糖苷类耐药基因10种,以AAC（6'）-Ib-cr和AAC（3）-IIa为主,检出率分别为71.43%和67.86%;喹诺酮类耐药基因4种,主要为oqxA和AAC（6'）-Ib-cr,检出率分别为85.71%和71.43%,其中20株CRKP同时携带oqxA和AAC（6'）-Ib-cr;磷霉素耐药基因1种,为FosA6,检出率为100%;磺胺类耐药基因3种,主要为sul2和sul1,检出率分别为21.43%和17.86%。28株CRKP的药敏结果显示,对碳青霉烯类抗菌药物、头孢菌素类、喹诺酮类和β-内酰胺类/β-内酰胺酶抑制剂合剂的耐药率均为100%;对阿米卡星的耐药率为14.29%,未检出替加环素耐药株。28株CRKP对所测β内酰胺类抗菌药物的耐药表型与耐药基因型完全一致。结论该院分离的CRKP同时携带多种抗菌药物的耐药基因,呈现泛耐药表型,其耐药表型和耐药基因型有很高的一致性。

关键词: 肺炎克雷伯菌, 超广谱β内酰胺酶;, 耐药基因, 全基因组测序

Abstract: Objective To analyze the distribution of resistance genes of carbapenem-resistant Klebsiella pneumoniae （CRKP） in our hospital and the relationship between resistance genes and phenotypes. The results will provide reference for clinical treatment, prevention and control. Method The non-duplicated CRKP28 strains isolated from clinical specimens were collected. The bacteria were identified and tested for drug sensitivity by VITEK-2 compact automatic microorganism identification and drug susceptibility analyzer. The whole genome sequencing technology was used for sequencing. Results 47 drug resistance genes were detected. There were 3 carbapenem resistance genes, mainly blaKPC-2 gene （25 strains,89.29%）,blaNDM-5 gene（2 strains,7.14%） and blaOXA-48 gene（1 strain, 3.57%）; Extended-spectrum β-lactamases（ESBLs） resistance genes were mainly blaTEM-1,blaSHV-28,blaCTX-M-15 and blaOXA-33, and the detection rates were 89.29%,75. 00%,75.00% and 67.86%, respectively. AAC （6 '） -Ib-cr and AAC （3） -IIa were the main aminoglycoside resistance genes,the detection rates were 71.43% and 67.86%,respectively; oqxA and AAC （6 '） -Ib-cr were the main quinolone resistance genes, and the positive rates were 85.71% and 71.43%,respectively. Among them, 20 CRKP strains carried both oqxA and AAC （6 '） -Ib-cr; FosA6 was the resistant gene to fosfomycin, and the positive rate was 100%. There were three sulfonamides resistance genes, mainly sul2 and sul1,and the detection rates were 21.43% and 17.86%,respectively. The drug resistance of 28 strains of CRKP to carbapenems,cephalosporins, quinolones and β-lactams/β-lactamase inhibitor mixture was 100%; The resistant rate to amikacin was 14.29%,and no resistant strain to tigecycline was found. The resistance phenotype and genotypes of 28 strains of CRKP were completely consistent with the tested β-lactam antibiotics. Conclusion CRKP isolates from our hospital carry multiple antimicrobial resistance genes, showing a pan-resistant phenotype. The resistance phenotype and resistance genotype have a high consistency.

Key words: Klebsiella pneumonia, Extended-spectrum β-lactamases;, Resistance gene, Whole genome sequencing

中图分类号:

R446.5

谢强, 谢瑞玉, 徐添天. 碳青霉烯酶耐药肺炎克雷伯菌耐药基因分布及与表型相关性分析[J]. 临床输血与检验, 2021, 23(4): 501-506.

XIE Qiang, XIE Rui-yu, XU Tian-tian. Correlation Analysis of Antimicrobial Resistance and Resistance Genes of Carbapenem-resistant Klebsiella Pneumonia[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(4): 501-506.

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碳青霉烯酶耐药肺炎克雷伯菌耐药基因分布及与表型相关性分析

Correlation Analysis of Antimicrobial Resistance and Resistance Genes of Carbapenem-resistant Klebsiella Pneumonia

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