广东省肇庆市肺炎克雷伯菌临床分离株的耐药性与MLST分型研究

目的了解广东省肇庆市肺炎克雷伯菌(Klebsiella pneumoniae, KP)临床分离株的抗生素耐药情况及多位点序列分型(multilocus sequence typing, MLST)特征。方法收集肇庆市两家医院KP临床分离株63株,采用肉汤微量稀释法进行30种抗生素的体外药物敏感性试验,并对所有菌株进行多位点序列分型。结果 63株KP临床分离株的耐药谱特点可分为4类,即全敏感的高毒力肺炎克雷伯菌(hypervirulent K. pneumoniae, hvKP)、产超广谱β-内酰胺酶肺炎克雷伯菌(extended spectrumβ-lactamases K.pneumoniae, ESBLsKP)、耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistantK. pneumoniae, CRKP)和其他类型的多重耐药肺炎克雷伯菌(multidrug-resistant K. neumoniae,MDRKP);MLST分型结果显示63株临床分离株可分成41个ST型。其中,ESBLsKP以ST37型(9株,39.13%)为主,CRKP以ST11型(5株,62.50%)为主,hvKP以ST65(5株,25.00%)型和ST23(3株,15.00%)型为主,而其他类型的多重耐药KP的ST型(12株9种ST型)则呈现明显的多态性。结论我市肺炎克雷伯菌临床分离株的耐药情况比较严重,要加强院内感染监测,警惕其成为优势菌型并引发院内感染的风险。

Drug resistance and MLST typing of clinical isolates of Klebsiella pneumoniae in Zhaoqing,Guangdong

Objective To comprehend antibiotic resistance and MLST (multilocus sequence typing) typing characteristics of clinical isolates of Klebsiella pneumoniae in Zhaoqing city of Guangdong province. Methods 63 strains of K. pneumoniae isolates were collected from two hospitals in Zhaoqing. Drug sensitivity test of 30 antibiotics by broth dilution method and MLST of all the strains were conducted. Results The resistance spectrum of 63 clinical isolates of K. pneumoniae could be divided into four types, namely, full sensitive hvKP (hypervirulent K. pneumoniae), ESBLsKP (extended spectrum β-lactamases K. pneumoniae), CRKP (carbapenem-resistant K. pneumoniae), and other types of MDRKP (multidrug-resistant K. pneumoniae); the results of MLST typing showed that 63 strains of clinical isolates could be divided into 41 ST types, of which ESBLsKP was dominated by ST37 type (9 strains, 39.13%), and CRKP by ST11 type (5 strains, 62.50%). Mainly, hvKP with ST65 type (5 strains, 25.00%) and ST23 type (3 strains, 15.00%), and other types of multi drug resistant KP ST (12 strains of 9 kinds of ST type) showed obvious polymorphism. Conclusion The drug resistance of Zhaoqing K. pneumoniae clinical isolates was serious. It is necessary to strengthen the monitoring of nosocomial infections and prevent the resisant K. pneumoniae from becoming the dominant type and causing the risk of nosocomial