耐碳青霉烯类肺炎克雷伯菌耐药基因检测及同源性

摘要

Objective To explore the drug-resistant genotypes and homology of carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods 38 strains of clinically isolated CRKB in a hospital between September 2015 and February 2016 were collected,drug resistance genes were detected with polymerase chain reaction (PCR),homology of strains was analyzed with pulsed-field gel electrophoresis (PFGE).Results All 38 strains were from intensive care unit(ICU) and surgical intensive care unit(SICU),accounting for 39.48％ and 34.21 ％ respectively.38 strains all harboured drug resistance genes blaKPC and blaSHV,6 strains harboured blaCTT.PFGE revealed that strains were divided into types A,B,C,and D,type C was predominant(65.78％,25/38).Of type A strains,strains 14,15,and 16 carried drug resistance genes blaKPC 2,blaSHV,and blaCTT-M-15 respectively,these strains were all isolated from SICU patients,strains 14 and 15 were isolated on the same day,strain 16 was isolated on the following week;of type C strains,homology of strain 10,18,25,and 28 was 100％.strian 10 and 18 were isolated from ICU patients,strains 25 and 28 were isolated from patients in division I of neurology ICU(both were transferred from ICU),and both were isolated during patient hospitalization in ICU,the isolation time only differed for one day.Conclusion The main drugresistant genotypes of CRKB in this hospital are mainly blaKPC and blaSHV,there is epidemic of clone strains in this hospital.%目的 探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)耐药基因型及同源性.方法 收集某院2015年9月-2016年2月临床标本分离的38株CRKP,采用聚合酶链反应(PCR)方法检测耐药基因型,脉冲场凝胶电泳(PFGE)分析菌株同源性.结果 38株CRKP主要来源于重症监护病房(ICU)及外科重症监护病房(SICU),分别占39.48％、34.21％.38株CRKP均检出blaKPC和blaSHV耐药基因,6株检出blacTX耐药基因.PFGE显示共分成A、B、C、D4个谱型,其中以C型为主(65.78％,25/38).A型菌株中菌株14、15、16携带blaKPC-2型、blaSHV型、blaCTX-M-45耐药基因,此3株细菌均是SICU患者分离的,菌株14和15分离自同一天,菌株16分离时间延后一周;C型菌株中,菌株10、18、25、28的同源性为100％,菌株10、18分离自ICU患者,菌株25、28分离自神经内一科患者(均从ICU转出),均是在ICU住院期间检出,且分离时间相差1d.结论 该院CRKP耐药基因型以blaKPC及blaSHV为主,存在克隆株医院内流行.