重症监护室患者及物表中分离的碳青霉烯耐药肺炎克雷伯菌分子流行病学与耐药机制分析

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摘要目的了解重症监护室（ICU）患者及物表中分离的碳青霉烯耐药肺炎克雷伯菌（CRKP）的耐药机制与分子流行特征，结合该病区实际情况采取合理的策略阻断其在医院内的传播，为临床合理用药和医院感染控制提供重要依据。方法收集2019年7月至2020年6月成都市新都区人民医院（以下简称“我院”）在ICU患者与物表分离的CRKP菌株29株；采用MicroScan WalkAway40细菌鉴定药敏分析仪和纸片扩散法测定临床常见抗菌药物的耐药性，聚合酶链式反应（PCR）扩增和DNA序列分析检测5种常见碳青霉烯酶耐药基因，多点位序列分型（MLST）和脉冲场凝胶电泳（PFGE）检测菌株间基因相关性。结果 29株CRKP对替加环素、多黏菌素均敏感，对阿米卡星、庆大霉素敏感率较高，对其他常见抗菌药物耐药率较高；PCR及DNA测序显示29株CRKP中，仅有1株为KPC-2型；其余28株结果均为NDM-1型；未检测出其他耐药基因型。MLST及PFGE检测结果显示，29株CRKP菌株共6种分型，以ST12型为主，检出ST12型CRKP菌株22株，ST12/A型11株、ST12/B型6株，物表分离株为ST12/A型。结论我院ICU病区中CRKP以产NDM-1型碳青霉烯酶ST12/A型为主，物表分离株与该病区流行菌株型别一致，同源性程度高，相关科室应加强对CRKP院内传播的干预，明确传播途径，采取一系列防控措施，防止耐药菌株在医院内传播。

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	陈涛唐娇杜晶晶刘小花陈静

关键词 ：碳青霉烯耐药肺炎克雷伯菌, 多位点序列分型技术, 脉冲场凝胶电泳技术, 耐药机制

Abstract：Objective To understand the drug resistance mechanism and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from patients and object surface in the intensive care unit (ICU), and to adopt reasonable strategies to block its transmission in hospital based on the actual situation of this ward, so as to provide an important basis for clinical rational drug use and nosocomial infection control. Methods A total of 29 strains of CRKP isolated from ICU patients and object surface in Xindu District People’s Hospital of Chengdu (hereinafter referred to as “our Hospital”) from July 2019 to June 2020 were collected. The antimicrobial resistance of common clinical antibiotics was detected by MicroScan WalkAway40 bacterial susceptibility analyzer and paper diffusion method. Five common carbapenem-resistant genes were detected by polymerase chain reaction (PCR) amplification and DNA sequence analysis. The gene correlation among the strains was detected by multilocus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE). Results A total of 29 strains of CRKP were sensitive to Tigecycline and Polymyxin, and had high sensitivity to Amikacin and Gentamicin, and high resistance to other common antibacterial drugs. PCR and DNA sequencing showed that among 29 strains of CRKP, only one strain was KPC-2 type. The other 28 strains were NDM-1 type. No other resistance genotypes were detected. MLST and PFGE detection results showed that 29 strains of CRKP were classified into six types, with ST12 type as the main type. A total of 22 strains of ST12 type CRKP, 11 strains of ST12/A type and six strains of ST12/B type were detected. The object surface strain was ST12/A type. Conclusion In ICU ward of our hospital, NDM-1 carbapenemase ST12/A type is the main type of CRKP, and the isolated strains on the object surface are consistent with the epidemic strains in this area, with high homology. Relevant departments should strengthen the intervention of nosocomial transmission of CRKP, clarify the transmission route, and take a series of prevention and control measures to prevent the spread of drug-resistant strains in the hospital.

Key words： Carbapenem-resistant Klebsiella pneumoniae Multilocus sequence typing Pulsed field gel electrophoresis Resistance mechanisms

基金资助:四川省医学（青年创新）科研课题（Q19050、S19076）。

引用本文:

陈涛唐娇杜晶晶刘小花陈静. 重症监护室患者及物表中分离的碳青霉烯耐药肺炎克雷伯菌分子流行病学与耐药机制分析[J]. 中国医药导报, 2021, 18(28): 160-163,172.
CHEN Tao TANG Jiao DU Jingjing LIU Xiaohua CHEN Jing. Molecular epidemiology and drug resistance mechanism analysis of carbapenem-resistant Klebsiella pneumoniae isolated from patients and object surface in the intensive care unit. 中国医药导报, 2021, 18(28): 160-163,172.

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