摘要
目的分析重症耐碳青霉烯肺炎克雷伯菌(CRKP)肺部感染影响因素及分子流行病学特点。方法选取海南西部中心医院及三亚市人民医院肺炎克雷伯菌培养阳性的375例重症肺部感染患者,根据临床标本中是否分离出CRKP分为CRKP组、碳青霉烯类敏感肺炎克雷伯菌(CSKP)组。分析重症肺部感染患者CRKP感染危险因素,以改良Hodge试验初筛CRKP碳青霉烯酶表型,聚合酶链反应(PCR)、质粒接合试验测定碳青霉烯基因携带与耐药基因水平转移,以脉冲场凝胶电泳(PFGE)分析克隆相关性。结果375例患者中共分离出非重复CRKP 105株,合并2种以上慢性病、感染前住院时间≥3周、留置插管>2种、应用碳青霉烯类药物≥1周、近3个月应用三代/四代头孢菌素为CRKP感染的独立危险因素(P<0.05);105株CRKP中,91株改良Hodge试验阳性(86.67%);91株改良Hodge试验阳性的CRKP菌株中79株携带blaKPC-2基因(86.81%),33株携带blaNDM-1基因(36.26%),3株携带blaIMP-4基因(3.30%),未发现blaVIM、blaOXA基因;91株CRKP菌株血清型均为阴性,但携带毒力基因uge 87株、mrk D88株、ybtS 84株、kpn 86株、ent B91株,91株CRKP质粒接合试验成功;PFGE聚类结果显示91株CRKP可分为7个克隆型(ST),ST11为主要ST型(58株,63.74%)。结论引起医院重症肺部感染患者CRKP感染的因素较多,而携带blaKPC-2及blaNDM-1基因是主要机制,ST11是其主要克隆型,需尽早制定防控措施。
OBJECTIVE To analyzed the influencing factors and molecular epidemiological characteristics of severe carbapenem-resistant Klebsiella pneumoniae(CRKP)pulmonary infection.METHODS A total of 375 patients with severe pulmonary infection who were positive for culture of K.pneumoniae in Hainan Western Central Hospital and Sanya People’s Hospital were enrolled in the study,the patients were divided into the CRKP group and the carbapenem-sensitive K.pneumoniae(CSKP)group according to the status of isolation of CRKP.The risk factors for CRKP infection were analyzed,the carbapenemase phenotypes of CRKP were screened by the modified Hodge test,the horizontal transfer of carbapenem genes and drug resistance genes was determined by means of polymerase chain reaction(PCR)and plasmid conjugation test,and the cloning correlation was analyzed by the pulsed field gel electrophoresis(PFGE).RESULTS Totally 105 strains of non-repetitive CRKP were isolated from 375 patients.Complication with more than 2 types of chronic diseases,length of hospital stay no less than 3 weeks before infection,more than 2 types of indwelling tubes,use of carbapenems no less than 1 week and use of the third or fourth generation of cephalosporins in the past 3 months were the independent risk factors for the CRKP infection(P<0.05).Among the 105 strains of CRKP,91(86.67%)were positive for the modified Hodge test.Among the 91 strains of CRKP positive for the modified Hodge test,79(86.81%)strains carried with bla KPC-2 gene,33(36.26%)strains carried with bla NDM-1gene,3(3.30%)strains carried with bla IMP-4 gene,and blaVIM or bla OXA gene was found.All of the 91 strains of CRKP were negative for serotypes,while 87 strains carried with virulence gene uge,88 strains carried with mrk D,84 strains carried with ybt S,86 strains carried with kpn,and 91 strains carried with ent B.The plasmid conjugation test for the 91 strains of CRKP was successful.PFGE clustering analysis showed that the 91 strains of CRKP could be divided into 7 clonotypes(ST),58(63.74%)of which carried with ST11.CONCLUSION There are a variety of risk factors for the CRKP infection in the patients with severe pulmonary infection,carrying with blaKPC-2 and blaNDM-1 genes is the main mechanism,ST11 is the predominant clonotype,and it is necessary to put forward prevention and control measures as early as possible.
作者
陈海
李华敏
刘丽霞
唐换灵
陈晓君
CHEN Hai;LIHua-min;LIU Li-xia;TANG Huan-ling;CHEN Xiao-jun(Hainan Western Central Hospital,Danzhou,Hainan 571700,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第13期2007-2011,共5页
Chinese Journal of Nosocomiology
基金
海南省医药卫生科研基金资助项目(1806032031A2001)。
关键词
重症肺部感染
耐碳青霉烯肺炎克雷伯菌
危险因素
耐药基因
毒力基因
分子流行病学
Severe pulmonary infection
Carbapenem-resistant Klebsiella pneumoniae
Risk factor
Drug resistance gene
Virulence gene
Molecular epidemiology
