【摘要】 目的 分析重症监护病房（ICU）临床来源耐碳青霉烯肺炎克雷伯菌（CRKP）的分子特征及流行情况，为感染控制及药物治疗提供实验室数据。方法 收集2018年7月—2020年7月某院ICU分离的51株CRKP,采用微量肉汤稀释法测定最低抑菌浓度，多位点序列分型和脉冲场凝胶电泳分析菌株同源性，检测菌株耐药和毒力基因，接合试验验证质粒的转移性。结果 药敏试验显示，CRKP对头孢他啶/阿维巴坦全部敏感，对替加环素耐药率最低（3.9%）,其次是阿米卡星（49.0%）、多粘菌素（64.7%）,对亚胺培南（96.1%）、美罗培南（98.0%）、左氧氟沙星（98.0%）和头孢他啶（100.0%）均高度耐药。51株CRKP中，mCIM试验阳性菌株49株（96.1%）,eCIM试验阳性菌株1株（2.0%）。碳青霉烯酶基因bla_KPC-2阳性菌株占96.1%。所有分离株中，高黏液表型阳性4株（7.8%）,毒力基因阳性情况分别为：uge 100.0%,mrkD 94.1%,kpn 94.1%,fim-H 72.5%,aero 2.0%,rmpA 2.0%。ST11 CRKP在ICU中占98.0%（50/51）,ST1373占2.0%（1/50）。检出1株ST1373的高毒力肺炎克雷伯菌。携带bla_KPC-2基因菌株的接合试验成功率为12.2%。结论 ICU存在产KPC-2的ST11 CRKP单克隆传播，同时携带一定的毒力基因。携带bla_KPC-2基因的质粒可通过接合水平传播。头孢他啶/阿维巴坦对CRKP有较高的敏感性，可供临床治疗选择使用。更多还原

【Abstract】 Objective To analyze the molecular characteristics and prevalence of carbapenem-resistant Klebsiella pneumoniae（CRKP） isolated from the intensive care unit（ICU）, and provide laboratory data for infection control and antimicrobial treatment.Methods 51 CRKP strains isolated from ICU of a hospital from July 2018 to July 2020 were collected, minimum inhibitory concentration（MIC） was determined by broth microdilution method, homology of strains was analyzed by multi-locus sequence typing（MLST） and pulsed-field gel electrophoresis（PFGE）, resis-tance and virulence genes of strains were detected, transferability of plasmid was verified with conjugation testing.Results Antimicrobial susceptibility testing showed that CRKP strains were all susceptible to ceftazidime/avibactam, resistance rate to tegacyclin was the lowest（3.9%）, followed by amikacin（49.0%） and polymyxin（64.7%）, while strains were all highly resistant to imipenem（96.1%）, meropenem（98.0%）, levofloxacin（98.0%） and ceftazidime（100.0%）. Among 51 CRKP strains, 49 strains（96.1%） were positive in mCIM testing, 1 strain（2.0%） was positive in eCIM testing. Carbapenemase gene bla_KPC-2 positive strains accounted for 96.1%. Among all isolates, 4 strains（7.8%） exhibited the hypermucoviscous phenotype, positive rates of virulence genes were uge（100.00%）, mrkD（94.1%）, kpn（94.1%）, fim-H（72.5%）, aero（2.0%）, and rmpA（2.0%）. ST11 and ST1373 CRKP accounted for 98.0%（50/51） and 2.0%（1/50） respectively among ICU strains. One highly virulent Klebsiella pneumoniae strain ST1373 was isolated. The success rate of conjugation testing of bla_KPC-2-harboring strains was 12.2%.Conclusion There is a monoclonal transmission of ST11 CRKP that produces KPC-2 in ICU, and it carries certain virulence genes. The plasmid of bla_KPC-2-harboring gene can be transmitted horizontally through conjugation. Ceftazidime/avibactam has high susceptibility to CRKP and can be used in clinical treatment.更多还原