丽水市中心医院产KPC酶肺炎克雷伯菌的分子流行病学研究

目的明确丽水市中心医院产KPC酶肺炎克雷伯菌的分子流行病学特征，为临床抗感染治疗提供实验依据。方法收集2011年3月至2015年10月丽水市中心医院分离的碳青霉烯类抗生素耐药肺炎克雷伯菌（CR-KP）。采用Vitek2-compact系统鉴定菌株并联合纸片扩散法（K-B法）检测其药敏，改良Hodge试验检测碳青霉烯酶；PCR法扩增KPC基因，测序后利用BLAST比对确定基因型；肠杆菌科基因间重复序列分型法（ERIC-PCR）联合多位点序列分型（MLST）鉴定菌种同源性；进而探讨产KPC酶肺炎克雷伯菌的分子流行病学特征。结果共收集到70株CR-KP，其中68株改良Hodge试验阳性，扩增产物测序结果均为blaKPC-2基因。ERIC-PCR结果显示，70株KPC型肺炎克雷伯菌分为A、B、C、D、E5个克隆群分别为63株(90.0%)、3株、2株、1株、1株；MLST分成6个ST型，其中ST11型63株（90.0%)，ST35型2株，ST1型2株，ST592、ST1883、ST494型均1株。结论丽水市中心医院碳青霉烯类耐药肺炎克雷伯菌的主要克隆群为ST11型，是我院流行感染的主要原因。

Genotyping of KPC-producing Klebsiella pneumoniae isolated from Lishui Central Hospital

Objective To identify the genotypes of KPC-producing Klebsiella pneumoniae isolated from Lishui Central Hospital. Methods Seventy clinical strains of carbapenem-resistant Klebsiella pneumoniae (CR-KP) were isolated from Lishui Central Hospital from March 2011 to October 2015. The strains were identified with Vitek2-compact system, and drug sensitivity was detected with disk diffusion method (K-B method) . The modified Hodge test was used to detect carbapenemase; KPC gene was amplified with PCR, and BLAST was used to determine the genotype after the sequencing. Enterobacteriaceae intergenic repetitive sequence classification (ERIC-PCR) and multiple loci sequence classification (MLST) were used to identify the homology of strains. Results Among 70 strains of CR-KP, 68 strains were modified Hodge test positive and confirmed to carry blaKPC-2 gene. ERIC-PCR showed that there were 63 strains of group A (90.0%), 3 of group B, 2 of group C, 1 of group D and 1 of group E. MLST showed that there were 63 strains of ST11(90.0%) , 2 of ST35, 2 of ST1, 1 of ST592, 1 of ST1883 and 1 of ST494, respectively. Conclusion ST11 is the main genotype of KPC-producing Klebsiella pneumoniae isolated from Lishui Central Hospital.