【摘要】 目的探讨碳青霉烯类耐药肺炎克雷伯菌的耐药基因分布及分子分型特征。方法收集38株临床分离的肺炎克雷伯菌,采用肉汤稀释法药敏实验、改良Hodge试验、PCR电泳、脉冲场凝胶电泳分型及多位点序列分型测定其耐药性、耐药基因型及分子型别。结果对碳青霉烯类药物亚胺培南、美罗培南、厄他培南耐药率分别为18.42%(7/38)、28.95%(11/38)、34.21%(13/38),其中有7株(18.42%)同时耐3种药物。对阿米卡星、左氧氟沙星、四环素、呋喃妥因、甲氨苄啶/磺胺甲恶唑、庆大霉素耐药率为23.68%~44.74%,阿莫西林/克拉维酸、头孢唑啉、头孢他啶、头孢曲松、头孢吡肟、氨曲南、环丙沙星耐药率均大于52.63%,氨苄西林、哌拉西林耐药率100%。有11株肺炎克雷伯菌碳青霉烯酶表型检测为阳性,占28.95%(11/38),其中5株携带blaKPC基因,均为KPC-2型;4株携带blaNDM基因,均为NDM-1型。9株携带blaKPC或blaNDM耐药基因的菌株同源性分析显示有8种不同PFGE带型,5种MLST型别(ST型)。5种ST型为ST11、ST15、ST395、ST1031、ST1412,其中以ST11为主。结论肺炎克雷伯菌耐药及多重耐药现象严重,肺炎克雷伯菌耐碳青霉烯类药物的主要的原因是携带KPC-2或者NDM-1基因,菌株基因型多态性大,提示病例之间不存在关联性。更多还原

【Abstract】 To reveal the distribution of resistance genes and molecular typing characteristics of carbapenem-resistant Klebsiella pneumoniae,38 clinical carbapenem-resistant K.pneumonia were collected and analyzed by broth dilution antibiotic susceptibility test,modified Hodge test,PCR and electrophoresis,pulsed-field gel electrophoresis typing(PFGE)and multilocus sequence typing(MLST).Results showed that 7(18.42%),11(28.95%),and 13(34.21%)strains showed resistance to imipenem,meropenem,ertapenem,respectively.Of which,7strains showed resistance to all three antibiotics,eleven strains showed positive results of modified Hodge test,and among them five and four strains carried KPC-2and NDM-1genes respectively.These nine strains showed eight different PFGE patterns,and five MLST types.In coclusion,antibiotic resistance among K.pneumoniaeis serious.KPC-2and NDM-1genes are the main cause of K.pneumoniae resistant to carbapenems.There was high genetic diversity exists in these strains,suggesting there might no direct relationship of these strains.更多还原