| 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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| 引用本文： | 李敏,李大兴,杨晨钰,傅超慧,熊一功,刘思健,凌云.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[J].现代预防医学,2019,0(12):2255-2260. |
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| 作者姓名： | 李敏 李大兴 杨晨钰 傅超慧 熊一功 刘思健 凌云 |
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| 作者单位： | 1. 湖南省长沙市长沙医学院医学检验学院 湖南 长沙 410219；2. 娄底中医院，湖南 娄底 417100 |
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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blaTEM、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。
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| 关 键 词： | hvKP 药敏试验 耐药基因 耐药性 |
Analysis of the drug resistance gene of 382 strains of hypervirulent Klebsiella pneumoniae in the First Affiliated Hospital of Changsha Medical University from 2014 to 2018 |
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| LI Min,LI Da-xing,YANG Chen-yu,FU Chao-hui,XIONG Yi-gong,LIU Si-jian,LING Yun.Analysis of the drug resistance gene of 382 strains of hypervirulent Klebsiella pneumoniae in the First Affiliated Hospital of Changsha Medical University from 2014 to 2018[J].Modern Preventive Medicine,2019,0(12):2255-2260. |
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| Authors: | LI Min LI Da-xing YANG Chen-yu FU Chao-hui XIONG Yi-gong LIU Si-jian LING Yun |
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| Affiliation: | *School of Medical Laboratory, Changsha Medical University, Changsha, Hunan 410219, China |
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| Abstract: | 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 cKP was blaCTXM,740 strains(89.5%). At the same time, blaSHV +blaCTXM +blaTEM was 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. |
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| Keywords: | hvKP Drug sensitivity test Drug-resistant gene Drug resistance |
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