重症医学科染KPC-2肺炎克雷伯菌的耐药情况分析及同源性研究

目的重症医学科染KPC-2肺炎克雷伯菌的耐药及同源性情况。方法从2018年4月至2019年2月于我院重症医学科室治疗的患者中提取40例耐碳青霉烯类肺炎克雷伯菌(CRKPN)菌株,对待测菌株进行药敏性试验、mCIM(改良碳青霉烯灭活试验)和eCIM(EDTA改良碳青霉烯灭活试验)联合试验,采用PCR扩增法检测待测菌的耐药基因并进行基因序列检测,采用PFGE对待测菌进行同源性分析。结果在16种抗菌药中,待测菌仅对阿米卡星(27.50%)、庆大霉素(17.50%)、妥布霉素(25.00%)、替加环素(100.00%)以及复方新诺明(55.00%)有敏感性;mCIM和eCIM试验结果显示40株CRKPN均产丝氨酸碳青霉烯酶;PCR试验结果显示待测菌株携带KPC基因阳性率为100%;选择ICU分离的17株CRKPN做PFGE,同源性结果分析显示该病区存在耐碳青霉烯肺炎克雷伯的克隆传播。结论我院重症医学科分离的CRKPN细菌的耐药机制是产丝氨酸碳青霉烯酶,酶基因为KPC-2型,PFGE结果分析显示我院重症医学科存在耐碳青霉烯肺炎克雷伯的克隆传播,需要加强院感监控工作。

An Analysis of Drug Resistance and Homology of KPC-2 Klebsiella Pneumoniae in Intensive Care Medicine

Objective To observe the drug resistance and homology of KPC-2 Klebsiella pneumoniae in intensive care medicine.Methods From April,2018 to February,2019,40 cases of carbapenem-resistant Klebsiella pneumoniae(CRKPN)strain were extracted from patients treated within intensive care unit of our hospital.The drug sensitivity test and mCIM were performed on the tested strains.In the eCIM test,the drug resistance gene of the testing bacteria was detected by PCR amplification method and the gene sequence was obtained,and the homology analysis was performed by using PFGE.Results Among the 16 antibacterial agents,the tested bacteria were only sensitive to amikacin(27.50%),gentamicin(17.50%),tobramycin(25.00%),tigecycline(100.00%)and compound Xinnuoming(55.00%).mCIM and eCIM test results showed that 40 strains of CRKPN produced serine carbapenemase.PCR results showed that the tested strains carried KPC gene with positive rate of 100%.We selected 17 ICU isolated CRKPN strains for PFGE.The homology analysis showed that there was a cloned propagation of carbapenem-resistant Klebsi in the ward.Conclusion The resistance mechanism of CRKPN bacteria isolated from the Department of Critical Care Medicine is the serine carbapenemase,and the enzyme gene is KPC-2.The results of PFGE analysis show that there is a carbapenem-resistant pneumonia in the Department of Critical Care Medicine.There is a big need to strengthen the hospital monitoring.