【摘要】 目的 研究多重耐药肺炎克雷伯菌（MDR-KP）中整合子和插入序列共同区（ISCR1）的分布特征和携带耐药基因情况，以及采用肠杆菌基因间重复共有序列聚合酶链反应（ERIC-PCR）分析MDR-KP的基因分型特点，为加强肺炎克雷伯菌耐药监测及临床用药提供可靠的理论依据。方法 收集南方医科大学南方医院临床分离的非重复的MDR-KP 68株作为实验菌株，提取细菌DNA,利用PCR检测常见的多重耐药基因型及Ⅰ、Ⅱ、Ⅲ类整合子和ISCR1,使用ERIC-PCR分析MDR-KP的基因型。结果 68株MDR-KP对氨曲南、头孢类、喹诺酮类和除头孢他啶/阿维巴坦外的酶抑制类药物耐药率高，大部分药物耐药率大于80.0%。检出的主要超广谱β-内酰胺酶基因型为bla_SHV型，主要碳青霉烯酶基因型为bla_KPC型。68株MDR-KP中，44株检出Ⅰ类整合子，检出率为64.7%,未检出Ⅱ类和Ⅲ类整合子基因，15株MDR-KP检出ISCR1,检出率为22.1%。Ⅰ类整合子携带最常见的基因盒为aadA2（16/44,36.4%）和aac（6′）-Ⅰb-cr5（14/44,31.8%）,其次为dfrA12+aadA2（3/44,6.8%）,ISCR1携带基因盒主要是qnrB91（9/15,60.0%）。ERIC-PCR结果显示，68株MDR-KP产生18种DNA指纹图谱，存在优势克隆型。结论 Ⅰ类整合子和ISCRI广泛存在于该院临床分离的MDR-KP中，主要携带氨基糖苷类耐药基因盒（aadA2）及喹诺酮类耐药基因盒[aac（6′）-Ⅰb-cr5和qnrB91],介导多重耐药性。该院临床分离的MDR-KP存在优势克隆型，应加强医院内感染防控措施，有效控制此类细菌的播散。更多还原

【Abstract】 Objective To study the distribution characteristics and drug resistance gene carriage of integrons and insertion sequence common region 1（ISCR1） in multidrug-resistant Klebsiella pneumoniae（MDR-KP）,and analyze the genotyping characteristics of MDR-KP using enterobacterial repetitive intergenic consensus polymerase chain reaction（ERIC-PCR） technology, in order to provide a reliable theoretical basis for strengthening the monitoring of drug resistance of Klebsiella pneumoniae and clinical medication.Methods A total of 68 non-repetitive MDR-KP strains isolated from clinical samples at Nanfang Hospital of Southern Medical University were collected as experimental strains.Bacterial DNA was extracted.Common multidrug-resistant genotypes and type Ⅰ,Ⅱ,and Ⅲ integrons and ISCR1 were detected by PCR,and the genotypes of MDR-KP were analyzed by using ERIC-PCR.Results The 68 MDR-KP strains had a high resistance rate to aztreonam, cephalosporins, quinolones, and enzyme inhibitor classes except ceftazidime/avibactam, and most of the resistance rates were greater than 80.0%.The main detected extended-spectrum β-lactamase（ESBL） genotype was bla_SHV type, and the main carbapenemase genotype was bla_KPC type.Among the 68 MDR-KP strains, type Ⅰ integrons were detected in 44 strains, with a detection rate of 64.7%.Type Ⅱ and Ⅲ integron genes were not detected.ISCR1 was detected in 15 MDR-KP strains, with a detection rate of 22.1%.The most common gene cassettes carried by type Ⅰ integrons were aadA2（16/44,36.4%） and aac（6′）-Ⅰb-cr5（14/44,31.8%）,followed by dfrA12+aadA2（3/44,6.8%）.The main gene cassette carried by ISCR1 was qnrB91（9/15,60.0%）.ERIC-PCR results showed that 68 MDR-KP strains produced 18 DNA fingerprint patterns, and there was a dominant clone type.Conclusion Type Ⅰ integrons and ISCR1 are widely present in MDR-KP isolated from clinical samples in this hospital, mainly carrying aminoglycoside resistance gene cassettes（aadA2） and quinolone resistance gene cassettes [aac（6′）-Ⅰb-cr5 and qnrB91],mediating multidrug resistance.There is a dominant clone type of MDR-KP isolated from clinical samples in this hospital, and infection prevention and control measures in the hospital should be strengthened to effectively control the spread of such bacteria.更多还原