Chinese Medical Sciences Journal ›› 2017, Vol. 32 ›› Issue (2): 107-112.doi: 10.24920/J1001-9294.2017.018

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耐碳青霉烯类肺炎克雷白杆菌临床分布及整合素1与其耐药关系的研究

欧琴1, 李文仿2, 李蓓1,*(), 于春芳1   

  1. 1 湖北医药学院医学微生物教研室
    2 湖北医药学院附属太和医院感染研究所
  • 收稿日期:2014-04-17 出版日期:2017-06-20 发布日期:2017-06-10
  • 通讯作者: 李蓓 E-mail:151449176@qq.com

Prevalence of Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) and the Distribution of Class 1 Integron in Their Strains Isolated from a Hospital in Central China

Ou Qin1, Li Wenfang2, Li Bei1,*(), Yu Chunfang1   

  1. 1Department of Medical Microbiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
    2Laboratory of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
  • Received:2014-04-17 Online:2017-06-20 Published:2017-06-10
  • Contact: Li Bei E-mail:151449176@qq.com

摘要:

目的 研究耐青霉烯类肺炎克雷白杆菌(Carbapenem-Resistant Klebsiella Pneumoniae, CRKP)临床分布,及整合素1在CRKP多药耐药中的作用。方法 在三年间从中国中部城市一家医院的多个科室采集唾液、血液及多种引流液临床标本,分离肺炎克雷白杆菌并鉴定CRKP。 细菌药敏实验分析CRKP对13中抗生素的耐药情况。PCR扩增CRKP整合素1的可变区域,通过酶切及DNA测序技术分析整合素1可变区域的基因结构。结果 共955例肺炎克雷白杆菌被分离出,其中CRKP共117例(12.3%)。2013,2014,2015年的Kp菌株中CRKP的分离率分别为8.9% (26/292),11.31% (38/336)及16.21% (53/327),呈逐步上升趋势。44.4% (52/117)的CRKP从ICU分离获得,61.5% (72/117)从痰液分离获得。117株CRKP中95% 对氨苄西林/舒巴坦、氨曲南、亚胺培南、美罗培南、头孢他啶、头孢噻肟、头孢吡肟及哌拉西林耐药,但对替加环素和多粘菌素的耐药率较低,分别为12.8%和35.9%。CRKP中整合素1阳性检测率为77.8% (91/117),整合素1与妥布霉素,庆大霉素及阿米卡星这三种氨基糖苷类抗生素耐药密切相关(P<0.01)。整合素1可变区域基因盒检测显示,aadA2占64.84% (59/91), aacA4 catB8-aadA1占23.1% (21/91), 及aadA2-dfrA25占12.1% (11/91)。结论 CRKP有逐年增多的趋势,大部分同时具备多药耐药。整合素1介导的耐药基因盒在CRKP对氨基糖苷类抗生素耐药中发挥重要作用,其中aadA2是最常见的耐药基因。

关键词: 碳青霉烯类,, 肺炎克雷白杆菌, 整合素1, 基因盒

Abstract:

Objective The aim of our study is to investigate the prevalence of Carbapenem-resistant Klebsiella pneumoniae (CRKP) and the genetic characteristics of the class 1 integron in CRKP on multi-drug resistance.Methods Clinical Klebsiella pneumoniae strains were collected from multiple departments of a hospital in central China. CRKP strains were identified among the isolates, and antibiotics susceptibility of CRKP strains was analyzed. The polymerase chain reaction (PCR) was adopted to amplify the class 1 integron variable area. The integron genetic structure was analyzed with enzyme digestion and DNA sequencing technology. The relation between class 1 integron and drug resistance was analyzed statistically.Results Totally 955 strains of Klebsiella pneumoniae were isolated from varied sites of the hospital, and 117(12.3%) of them were identified as CRKP, with a separation rate of 8.9% (26/292) in 2013, 11.3% (38/336) in 2014 and 16.2% (53/327) in 2015, which shows an increasing trend by year. 44.4% (52/117) of CRKP strains were separated from specimen of ICU, and 61.5% (72/117) were from sputum. Over 95% CRKP strains were resistant to ampicillin/sulbactam, aztreonam, imipenem, meropenem, ceftazidme, cefotaxime, cefepime,and piperacillin, while relatively low resistant rates were found in tigecycline (12.8%) and colistin (35.9%). The class 1 integron was detected in 77.8% (91/117) of CRKP strains. Class 1 integron of CRKP was significantly correlated with the antibiotic resistance to the tobramycin, gentamicin and amikacin (all P<0.01). The gene cassette analysis of variable area of class 1 integron showed that aadA2 accounts for 64.8% (59/91), aacA4-catB8-aadA1 23.1% (21/91), and aadA2-dfrA25 12.1% (11/91).Conclusions CRKP has an increasing trend in a clinical setting in China, and most of them were resistant to multiple antibiotics. Class 1 integron in CRKP has strong ability to capture the genes resistant to aminoglycosides antibiotics from environment, with the aadA2 gene as the most popular one.

Key words: carbapenem resistance, klebsiella pneumoniae, integron, gene cassette

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