FOLLOWUS
- Share with wechat friends or circle of friends
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
- Affiliations：
1. 1Department of Medical Microbiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
2. 2Laboratory of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
- Author bio：
*Corresponding author Tel: 86-0719-8891151, E-mail: 151449176@qq.com
- Funds：△Supported by the Fund of Hubei 2011 Cooperative Innovation Center (2011JH-2013CXTT01).
DOI：10.24920/J1001-9294.2017.018
中图分类号：收稿日期：2014-04-17，
网络出版日期：2017-06-20，
纸质出版日期：2017-06
- Accepted：
Scan QR Code
欧琴, 李文仿, 李蓓, 等. 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[J]. 中国医学科学杂志（英文版）, 2017,32(2):107-112.
Ou Qin, Li Wenfang, Li Bei, et al. Prevalence of Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) and the Distribution of Class 1 Integron in Their Strains Isolated from a Hospital in Central China[J]. Chinese medical sciences journal, 2017, 32(2): 107-112.
欧琴, 李文仿, 李蓓, 等. 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[J]. 中国医学科学杂志（英文版）, 2017,32(2):107-112. DOI： 10.24920/J1001-9294.2017.018.
Ou Qin, Li Wenfang, Li Bei, et al. Prevalence of Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) and the Distribution of Class 1 Integron in Their Strains Isolated from a Hospital in Central China[J]. Chinese medical sciences journal, 2017, 32(2): 107-112. DOI： 10.24920/J1001-9294.2017.018.
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。
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.
关键词
Keywords
references
Jia Li , Fei Liu , Qi Wang , et al. Genomic and transcriptomic analysis of NDM-1 Klebsiella pneumoniae in spaceflight reveal mechanisms underlying environmental adaptability. Sci Rep 2014 ; 4 : 6216 . doi: 10.1038/srep06216 10.1038/srep06216 .
Camargo JF , Simkins J , Beduschi T , et al. Successful treatment of Carbapenemase-producing pandrug-resistant Klebsiella pneumoniae bacteremia. Agents Chemother 2015 ; 59 : 5903 - 8 . doi: 10.1128/AAC.00655-15 10.1128/AAC.00655-15 .
Messina JA , Cober E , Richter SS , et al. Hospital readmissions in patients with carbapenem-resistant Klebsiella pneumoniae. Infect Control HospEpidemiol 2016 ; 37 : 281 - 8 . doi: 10.1017/ice.2015.298 10.1017/ice.2015.298 .
Saidel-Odes L , Borer A. Limiting and controlling carbapenem-resistant Klebsiella pneumoniae. Infect Drug Resist 2013 ; 7 : 9 - 14 . doi: 10.2147/IDR.S44358 10.2147/IDR.S44358 .
Liu LT , Wan LH , Song XH , et al. Relevance of class 1 integrons and extended-spectrum β-lactamases in drug- resistant Escherichia coli. Mol Med Rep 2013 ; 8 : 1251 - 5 . doi: 10.3892/mmr.2013.1626 10.3892/mmr.2013.1626 .
Pan YJ , Lin TL , Lin YT , et al. Identification of capsular types in carbapenem-resistant Klebsiellapneumoniae strains by wzc sequencing and implications for capsule depolymerase treatment. Antimicrob Agents Chemother 2015 ; 59 : 1038 - 47 . doi: 10.1128/AAC.03560-14 10.1128/AAC.03560-14 .
Diago-Navarro E , Chen L , Passet V , et al. Carbapenem- resistant Klebsiella pneumoniae exhibit variability in capsular polysaccharide and capsule associated virulence traits. J Infect Dis 2014 ; 210 : 803 - 13 . doi: 10.1093/infdis/jiu157 10.1093/infdis/jiu157 .
Odumosu BT , Adeniyi BA , Chandra R. Analysis of integrons and associated gene cassettes in clinical isolates of multidrug resistant Pseudomonas aeruginosa from Southwest Nigeria. Ann Clin Microbiol Antimicrob 2013 ; 12 : 29 . doi: 10.1186/1476-0711-12-29 10.1186/1476-0711-12-29 .
Rocha LK , dos Santos Neto RL , da Costa Guimarães AC , et al . Plasmid-mediated qnrA1 in Klebsiella pneumoniae ST147 in Recife, Brazil. Int J Infect Dis 2014 ; 26 : 49 - 50 . doi: 10.1016/j.ijid.2014.04.026 10.1016/j.ijid.2014.04.026 .
Candan ED , Aksöz N. Klebsiella pneumoniae: characteristics of carbapenem resistance and virulence factors. ActaBiochim Pol 2015 ; 62 : 867 - 74 . doi: 10.18388/abp.2015_ 1148 10.18388/abp.2015_ 1148 .
Shields RK , Clancy CJ , Hao B , et al. Effects of Klebsiella pneumoniae carbapenemase subtypes, extended-spectrum β-lactamases, and porin mutations on the in vitro activity of ceftazidime-avibactam against carbapenem-resistant K. pneumoniae. Antimicrob Agents Chemother 2015 ; 59 : 5793 - 7 . doi: 10.1128/AAC.00548-15 10.1128/AAC.00548-15 .
Guo W , Shan K , Xu B , et al. Determining the resistance of carbapenem-resistant Klebsiella pneumoniae to common disinfectants and elucidating the underlying resistance mechanisms. Pathog Glob Health 2015 ; 109 : 184 - 92 . doi: 10.1179/2047773215Y.0000000022 10.1179/2047773215Y.0000000022 .
Agodi A , Barchitta M , Quattrocchi A , et al. Antibiotic trends of Klebsiella pneumoniae and Acinetobacter baumannii resistance indicators in an intensive care unit of Southern Italy, 2008-2013. Antimicrob Resist Infect Control 2015 ; 4 : 43 . doi: 10.1186/s13756-015-0087-y 10.1186/s13756-015-0087-y .
Hosan Kim , Inder Makin , Jeff Skiba , et al. Antibacterial efficacy testing of a bioelectric wound dressing against clinical wound pathogens. Open Microbiol J 2014 ; 8 : 15 - 21 . doi: 10.2174/1874285801408010015 10.2174/1874285801408010015 .
Mouloudi E , Massa E , Piperidou M , et al. Tigecycline for treatment of carbapenem-resistant Klebsiella pneumonia infections after liver transplantation in the intensive care unit: a 3-year study. Transplant Proc 2014 ; 46 : 3219 - 21 . doi: 10.1016/j.transproceed.2014.09.160 10.1016/j.transproceed.2014.09.160 .
Lee JY , Choi MJ , Choi HJ , et al. Preservation of acquired colistinresistance in Gram-negative bacteria. Antimicrob Agents Chemother 2015 ; 60 : 609 - 12 . doi: 10.1128/AAC.01574-15 10.1128/AAC.01574-15 .
Chaari A , Mnif B , Chtara K , et al. Efficacy of tigecycline- colistin combination in the treatment of carbapenem- resistant Klebsiella pneumoniae endocarditis. J Glob Antimicrob Resist 2015 ; 3 : 214 - 16 . doi: 10.1016/j.jgar.2015.06.003 10.1016/j.jgar.2015.06.003 .
Yang HS , Fang WL , Lin YT. A case of liver abscess caused by tigecycline-nonsusceptible Klebsiella pneumoniae. J Microbiol Immunol Infect 2016 ; 49 : 621 - 2 . doi: 10.1016/j.jmii.2016.04.010 10.1016/j.jmii.2016.04.010 .
Zeighami H , Haghi F , Hajiahmadi F. Molecular characterization of integronsin clinical isolates of betalactamase producing Escherichia coli and Klebsiella pneumoniaein Iran. J Chemother 2015 ; 27 : 145 - 51 . doi: 10.1179/1973947814Y.0000000180 10.1179/1973947814Y.0000000180 .
Huang YW , Hu RM , Lin YT , et al. The contribution of class 1 integron to antimicrobial resistance in Stenotrophomonasmaltophilia. Microb Drug Resist 2015 ; 21 : 90 - 6 . doi: 10.1089/mdr.2014.0072 10.1089/mdr.2014.0072 .
Yuejin Z , Qingli C , Qian W , et al. Structure and function of class 1 integronin clinical isolates of Klebsiella pneumoniae . Yi Chuan 2014 ; 36 : 603-10 . Chinese. doi: 10.3724/SP.J.1005.2014.0603 10.3724/SP.J.1005.2014.0603 .
Li B , Hu Y , Wang Q , et al. Structural diversity of class 1 integrons and their associated gene cassettes in Klebsiell- a pneumonia isolates from a hospital in China. PLoS One 2013 ; 8 : e75805 . doi: 10.1371/journal.pone.0075805 10.1371/journal.pone.0075805 .
Liu H , Wang H , Huang M , et al. Analysis of antimicrobial resistance and class 1 integrons among strains from upper respiratory tract of healthy adults. J Thorac Dis 2013 ; 5 : 149 - 55 . doi: 10.3978/j.issn.2072-1439.2013.03.09 10.3978/j.issn.2072-1439.2013.03.09 .
关联资源
相关文章
相关作者
相关机构
- © 2024 中国医学科学院 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies