重症监护病房耐碳青霉烯类肺炎克雷伯菌同源性分析

目的了解重症监护病房(ICU)分离的耐碳青霉烯类肺炎克雷伯菌的药敏结果及同源性。方法对2014年4—5月某院ICU患者和环境分离的11株耐碳青霉烯类肺炎克雷伯菌进行药敏试验,以及采用随机扩增多态性DNA(RAPD)扩增法进行同源性分析。结果 11株肺炎克雷伯菌8株分离自患者,3株分离自环境,标本分布以痰为主(6株,占54.55%)。药敏试验结果显示:10株(90.91%)对环丙沙星耐药;11株对复方磺胺甲口恶唑均敏感,对亚胺培南均为中介,对其余抗菌药物耐药率均为100%。11株肺炎克雷伯菌均有3个条带,可以分为2型:Ⅰ型10株(1~5号、7~11号菌株),Ⅱ型1株(6号菌株)。结论医院ICU肺炎克雷伯菌耐药严重,ICU患者和环境分离的耐碳青霉烯类肺炎克雷伯菌为同一克隆株。加强ICU环境清洁、消毒及监测,有利于减少和及时预警多重耐药菌,降低医院感染。

Homology of carbapenem resistant Klebsiella pneumoniae in an intensive care unit

ObjectiveTo understand antimicrobial resistance and homology of carbapenem resistant Klebsiella pneumoniae (CRKP) from an intensive care unit (ICU).Methods11 CRKP isolates from patients and environment of an ICU in a hospital were performed antimicrobial susceptibility testing, the homology of CRKP was analyzed by randomly amplified polymorphic DNA (RAPD) method.ResultsOf 11 CRKP isolates, 8 were from patients, and 3 from environment, the main specimen was sputum(n=6, 54.55%). Antimicrobial susceptibility testing results revealed that 10 (90.91%) CRKP isolates were resistant to ciprofloxacin; 11 isolates were susceptible to compound sulfamethoxazole, intermediate to imipenem, and resistant to other antimicrobial agents(100%). All 11 CRKP isolates had 3 bands, and were divided into two types: (type Ⅰ, n=10; type Ⅱ, n=1).ConclusionAntimicrobial resistance of Klebsiella pneumoniae in ICU is serious, CRKP isolated from ICU patients and environment are of the same clone. Cleaning, disinfection, and monitoring of ICU environment should be strengthened, which is helpful for reducing, timely warning of multidrug resistant organisms, and reducing healthcare associated infection.