【摘要】 目的 分析耐碳青霉烯肺炎克雷伯菌（CRKP）的耐药情况及耐药基因，为临床治疗提供依据。方法 收集并鉴定临床分离非重复CRKP 27株，采用VITEK-2 compact全自动微生物鉴定药敏分析仪鉴定和药敏试验，碳青霉烯酶抑制剂增强试验检测A类丝氨酸碳青霉烯酶和B类金属β内酰胺酶，聚合酶链反应（PCR）法和基因测序技术检测常见的耐药基因。使用肠杆菌科基因间重复一致序列PCR(ERIC-PCR)对菌株进行同源性分析。结果 27株肺炎克雷伯菌对碳青霉烯类、头孢菌素类、喹诺酮类等抗生素的耐药率均>96%。碳青霉烯酶抑制剂增强试验显示，26株A类丝氨酸碳青霉烯酶阳性，1株B类金属β内酰胺酶阳性。PCR和基因测序结果显示，26株CRKP携带KPC-2基因，1株携带NDM-1基因。ERIC-PCR将27株CRKP分为8型，以Ⅰ型和Ⅱ型为主。结论 分离的CRKP对临床常用抗生素表现出高水平耐药，其耐药机制主要是该类细菌产KPC-2型碳青霉烯酶。更多还原

【Abstract】 Objective To investigate the epidemiological characteristics and resistance mechanism of carbapenem-resistant Klebsiella pneumonia(CRKP),and provide the basis for the clinical treatment. Methods A total of 27 clinical strains of CRKP were collected and identified. The identificition and antibiotic susceptibility test were carried out with the automatic VITEK-2 compact system. Carbapenemase inhibitor enhancement test was usded to detect the carbapenem class A enzymes and the carbapenem class B enzymes. The carbapenemase resistance genes were detected by polymerase chain reaction(PCR)and DNA sequence analysis. The homology of resistant strains was analyzed by enterobacterial repetitive intergenic consensus-polymerase chain reaction(ERIC-PCR). Results The date showed that the resistant rate of CRKP to carbapenems,cephalosporins and quinolones were more than 96%. Carbapenemase inhibitor enhancement test showed that26 strains harboured the carbapenem class A enzymes and one had the carbapenem class B enzymes. PCR and DNA sequence analysis result showed that 26 strains were KPC-2 type and one was NDM-1. ERIC-PCR result showed that 27strains of CRKP were divided into 8 types,and the main type were type Ⅰ and Ⅱ. Conclusion The isolated CRKP showed a high level of resistance to clinical antibacterial drugs;its resistance mechanism was mainly the KPC-2 carbapenemase produced by these bacteria.更多还原