【摘要】 目的通过检测医院获得性血流感染患者来源碳青霉烯类耐药肺炎克雷伯菌(CRKP)及临床资料分析,了解CRKP血流感染检测程序及耐药机制,为临床诊治提供循证依据。方法收集2016年1月-2017年7月青岛市立医院血培养阳性分离株,采用BD PhoenixTM-100全自动细菌鉴定/药敏系统进行细菌/药敏鉴定筛选CRKP;改良Hogdge,PCR方法进行KPC、NDM、BIC、SPM、IMP、AIM、VIM、OXA、GIM、SIM、DIM等耐药基因检测,对PCR产物测序并进行BLAST比对;MLST方法进行基因分型。结果 2016年1月至2017年7月血培养阳性结果剔除重复后共分离菌株2124株,其中CRE共31株,占1.5%,其中CRKP 11株,占0.5%,3株来自ICU,2株来自呼吸科,2株来自急诊日间病房,1株来自新生儿科,1株来自普外科,1株来自老年保健科,1株来自神经内科。药敏结果显示:第三、第四代头孢菌素耐药严重,均产ESBL,除对多粘菌素全敏感外,阿米卡星、环丙沙星等耐药率均>70%;PCR结果显示:11株中有10株检出KPC基因,1株检出NDM,检出率分别为90.9%,和9.1%。MLST分型主要为ST2250、ST15、ST23、ST2193、ST1083。结论医院获得性CRKP菌株耐药严重,碳青霉烯酶耐药基因以KPC型为主,可嵌合其他耐药基因水平转移传播。更多还原

【Abstract】 Objective The aim of the study was to determine the carbapenem resistance profile of Klebsiella pneumoniae(CRKP)isolated from inpatients with acquired blood infections,to comprehensively analyze their clinical data,as well as to interrogate CRKP blood testing procedure,providing an evidence-based basis for clinical diagnosis and treatment.Methods Positive blood culture isolates were collected from Qingdao Municipal Hospital from January 2016 to July 2017.CRKP was identified through bacterial/susceptibility screening by using BD PhoenixTM-100 automatic bacterial identification/drug susceptibility system.Modified Hogdge and PCR method was used for testing drug-resistance of KPC,NDM,BIC,SPM,IMP,AIM,VIM,OXA,GIM,SIM,DIM gene.PCR products were then sequenced and compared through BLAST;MLST method was used for genotyping.Results A total of 2124 strains was isolated from the positive blood culture samples from January 2016 to July 2017.Among them,31 strains were CRE(1.4%),11 were CRKP,accounting for 0.5%(3 from ICU and 2 from the respiratory department,2 from the emergency day ward,the rest from the neonatology,the general surgery,the geriatrics department,and the neurology,respectively).Susceptibility results indicated a sever drug-resistance profile for the third and fourth generations of cephalosporins and all of them were ESBL-resistant strains.The resistance rates for amikacin and ciprofloxacin were more than 70%.All strains were susceptible to polymyxin.KPC mutation was detected in 10 out of 11 strains and NDM mutation in 1 strain,with the detection rates accounting for 90.9% and 9.1%,respectively.The results of MLST genotype mainly consist of ST2250,ST15,ST23,ST2193 and ST1083.Conclusion Hospital-acquired CRKP strains are highly drug-resistant.The majority of carbapenem-resistant genes belongs to KPC-type,which can be chimeric with other drug-resistant genes for horizontal transfer of transmission.更多还原