摘要
目的随着抗生素的不合理应用,耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant klebsiella pneumoniae,CRKP)感染率呈逐年增长趋势,对临床抗感染预防有严重影响。本研究旨在探讨CRKP耐药基因型和同源性,为临床预防及治疗提供参考。方法收集焦作市第四人民医院2017-07-01-2019-01-31临床分离的20株CRKP,采用碳青霉烯酶失活法试验和改良Hodge试验对产酶表型检测,耐药相关基因通过PCR方法扩增,试验菌的同源性采用质谱技术分析。结果阿米卡星和替加环素耐药率分别为70.00%和100.00%,其他抗菌药物耐药率均>90.00%。碳青霉烯酶改良Hodge试验(modified Hodge test,MHT)阳性和CIM菌阳性均为65.00%,两种表型符合率为92.31%。未检出基因的占20.00%,同时存在两种耐药基因的占25.00%,同时存在3种耐药基因的占35.00%。MHT菌株产碳青霉烯酶的特异度为85.71%,灵敏度为92.31%,假阳性率和假阴性率均为7.69%。CIM菌株产碳青霉烯酶的特异度为100.00%,灵敏度为100.00%。20株细菌质谱同源性主要有B型(35.00%)及A型(65.00%)。结论 CRKP分离率较高,通常携带多种耐药基因型。A型是同源性的重要流行株。
OBJECTIVE With the unreasonable application of antibiotics,the carbapenem-resistant klebsiella pneumoniae(CRKP)infection rate has been increasing year by year,which has a serious impact on clinical anti-infection prevention.This study aims to investigate CRKP resistance genotype and homology provide effective reference for clinical prevention and treatment.METHODS Retrospective analysis of 20 carbapenem-resistant Klebsiella pneumoniae clinically isolated in our hospital was taken out from July 01,2017 to January 31,2017.The carbapenemase inactivation test and modified Hodge test enzyme production table Type detection,resistance-related genes are amplified by PCR,and homology of test bacteria was analyzed by mass spectrometry.RESULTS The resistance rates of amikacin and tigecycline were70.00% and 100.00%,respectively,and the resistance rates of other antibacterial drugs were>90.00%.The carbapenemase-positive MHT-positive and CIM-positive was 65.00%,and the coincidence rate of the two phenotypes was92.31%.20.00% of the genes were not detected,25.00% of the two resistance genes were present,and 35.00% of the three resistance genes were present.The specificity of carbapenemase produced by MHT strain was 85.71%,the sensitivity was 92.31%,and the false positive rate and false negative rate were both 7.69%.The specificity of carbapenemase produced by CIM strain was 100.00%,and the sensitivity was 100.00%.The homology of mass spectrometry of 20 strains was mainly 35.00% of type B and 65.00%of type A.CONCLUSIONS CRKP has a high isolation rate and usually carries multiple resistant genotypes.Type A is an important epidemic strain of homology.
作者
刘静
刘俊华
LIU Jing;LIU Jun-hua(Department of Laboratory,Fourth People’s Hospital of Jiaozuo,Jiaozuo 454000,P.R.China)
出处
《社区医学杂志》
2020年第12期865-868,共4页
Journal Of Community Medicine
关键词
耐碳青霉烯类肺炎克雷伯菌
耐药基因型
同源性
carbapenem-resistant Klebsiella pneumoniae
drug-resistant genotypes
homology
