【摘要】 目的 了解南宁地区某院碳青霉烯类耐药肺炎克雷伯菌(CRKP)的耐药性及碳青霉烯酶产生情况，为CRKP感染防控提供依据。方法 收集2021年1月至2022年2月临床分离的CRKP共46株，用Phoenix M50全自动微生物鉴定药敏分析仪进行药敏试验，采用碳青霉烯酶抑制剂增强试验进行碳青霉烯酶表型筛选，用PCR扩增碳青霉烯酶耐药基因。结果 46株CRKP对厄他培南100%耐药，对亚胺培南和美罗培南的耐药率分别为76.1%和78.3%，对除氨曲南外的其他β-内酰胺类药物的耐药率均为100%，对替加环素耐药率为0，对多黏菌素B(4.3%)及阿米卡星(32.6%)耐药率较低；碳青霉烯酶表型筛选试验检出单产A类碳青霉烯酶菌株33株(71.7%)，单产B类金属β-内酰胺酶9株(19.6%)，单产D类OXA-48型碳青霉烯酶2株(4.3%)，同时产A类和B类碳青霉烯酶2株(4.3%);46株CRKP均检出碳青霉烯酶耐药基因，其中，33株(71.7%)仅携带KPC-2基因，7株(15.2%)仅携带NDM-1基因，2株(4.3%)仅携带VIM-1基因，2株(4.3%)仅携带OXA-48基因，2株(4.3%)同时携带KPC-2和NDM-1基因，未检出IMP型。结论某院分离的CRKP对常见抗菌药物具有高度耐药性，主要产KPC-2型碳青霉烯酶，应加强抗菌药物合理使用、CRKP酶型检测与感染控制，有效防范院内感染。更多还原

【Abstract】 Objective To investigate the drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)and the production of carbapenemase in a hospital of Nanning and provide evidence for the prevention and control of CRKP infection. Methods A total of 46 strains of CRKP were collected from January 2021 to February 2022.Antimicrobial susceptibility test of CRKP strains was detected by Phoenix M50 automatic microbial identification and drug sensitivity analyzer, and carbapenemase inhibitor enhancement method was used to detect carbapenemase phenotype. Polymerase chain reaction(PCR) was used to amplify the carbapenemase-encoding drug resistance genes. Results The 46 strains of CRKP were 100% resistant to ertapenem, 76.1% resistant to imipenem and 78.3%resistant to meropenem, respectively. Except for aztreonam, the strains were 100% resistant to β-lactam antibiotics.The resistance rate to tigecycline was 0, and the resistance rate to polycolistin B(4.3%) and amikacin(32.6%) was low. Carbapenemase resistance gene was detected in 46 CRKP strains, of which 33 strains(71.7%) only carried KPC-2 gene, 7 strains(15.2%) carried NDM-1 gene, 2 strains(4.3%) carried VIM-1 gene, and 2 strains(4.3%) carried OXA-48 gene. Two strains(4.3%) carried both KPC-2 and NDM-1 genes, while IMP genotype was not detected.Carbapenemase resistance gene was detected in 46 CRKP strains, of which 33 strains(71.7%) only carried KPC-2 gene, 7 strains(15.2%) carried NDM-1 gene, 2 strains(4.3%) carried VIM-1 gene, and 2 strains(4.3%) carried OXA-48 gene. Two strains(4.3%) carried both KPC-2 and NDM-1 genes, while IMP genotype was not detected..Conclusion CRKP isolated from a hospital is highly resistant to the common antibacterial drugs and mainly produces KPC-2 carbapenemase. The rational use of antibiotics, detection of CRKP enzyme type and infection control should be strengthened to effectively prevent nosocomial infection.更多还原