| 陆颖,王春.肺炎克雷伯菌的耐药性、毒力及外排泵分布特点的分析[J].安徽医药,2026,30(5):963-968. |
| 肺炎克雷伯菌的耐药性、毒力及外排泵分布特点的分析 |
| Analysis of antibiotic resistance and virulence of Klebsiella pneumoniae and distribution characteristics of efflux pumps |
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| DOI：10.3969/j.issn.1009-6469.2026.05.023 |
| 中文关键词: 肺炎克雷伯菌 耐药性 毒力 外排泵 |
| 英文关键词: Klebsiella pneumoniae Resistance Virulence Efflux pump |
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| 中文摘要: |
| 目的研究肺炎克雷伯菌( KP)的耐药性和毒力以及外排泵的临床分布特点。方法收集蚌埠医科大学第二附属医院 2018年 8月至 2022年 3月分离的 120株非重复 KP菌株，药敏试验采用微量肉汤稀释法，双试纸扩散法检测产超广谱 β-内酰胺酶( ESBLs)，改良碳青霉烯灭活试验检测碳青霉烯酶，拉丝试验进行高黏液表型检测，聚合酶链式反应( PCR)检测耐药基因及外排泵。结果经典肺炎克雷伯菌( cKP)对头孢唑啉、头孢曲松、氨苄西林 /舒巴坦、妥布霉素、庆大霉素、甲氧苄啶 /磺胺甲 ..唑的耐药性明显高于高毒力肺炎克雷伯菌( hvKP)。 cKP中的多重耐药( MDR)菌株及携带 ESBLs的菌株明显高于 hvKP(P<0.05)。然而，碳青霉烯耐药菌株在 hvKP与 cKP中差异无统计学意义。 MDR肺炎克雷伯菌株中， 38株产 ESBLs菌株均携带 blaCTX-M。其次，还携带 blaSHV(37株，占 97.4%)和 blaTEM(24株，占 63.2%)。 39株产碳青霉烯酶菌株中，检测出耐药基因包括 blaKPC(31株，占 79.5%)blaVIM(13株，占 33.3%)以及 blaNDM(12株，占 30.8%)；外排泵基因包括 AcrA(36株，占 92.3%)、 AcrB(37株，占 94.9%)、 TolC(35株，占 89.7%)、 OqxA(30株，占 76.9%)、 OqxB(30株，占 76.9%)、 KdeA(38株，占 97.4%)、 KpnE(38株，占97.4%)、 KetM(38株，占 97.4%)、 RobA(37株，占 94.9%)、 MarA(37株，占 94.9%)、 RamA(36株，占 92.3%)以及 KexD(25株，占 64.1%)。 20株多重耐药高毒力肺炎克雷伯菌( MDR-hvKP)菌株中， 14株为碳青霉烯耐药的高毒力肺炎克雷伯菌。其中， 1株携带 blaKPC和 blaNDM，6株同时携带 blaKPC和 blaVIM。结论发现多株 MDR-hvKP菌株，具有多耐药性和高毒力，其中具有高毒力的碳青霉烯耐药菌株同时还携带多种外排泵基因。这将增加临床诊断和治疗的难度。 |
| 英文摘要: |
| Objective To investigate the clinical distribution characteristics features of antibiotic resistance,virulence and efflux pumps in Klebsiella pneumoniae (KP).Methods A total of 120 non-repeated KP in the Second Affiliated Hospital of Bengbu MedicalUniversity from August 2018 to March 2022 were collected. The antimicrobial susceptibility testing of antibiotic were tested by thebroth microdilution method,and the positive strains producing extended spectrum beta-lactamases (ESBLs) and carbapenemase were de. tected by double-disc synergy test and modified carbapenem inactivation methodm respectively. The hypermucoviscous phenotype ofthe strain was tested by the string test.The antibiotic resistance genes and efflux pumps were detected by polymerase chain reaction(PCR).Results The resistance of classic Klebsiella pneumoniae(cKP) to cefazolin,ceftriaxone,ampicillin/sulbactam,tobramycin,genta.micin,and trimethoprim/sulfamethoxazole was significantly higher than that of hypervirulent Klebsiella pneumoniae (hvKP). Multidrug resistance (MDR) and ESBLs positive strains in cKP were significantly higher than those in hvKP(P<0.05).However,there was no signifi. cant difference between carbapenemases-producing strains in hvKP and cKP.Among the MDR isolates,thirty-eight ESBLs-producing strains carried blaCTX-M. followed by blaSHV (37,97.4%) and blaTEM (24,63.2%).Drug resistance genes were detected in thirty-nine carbapen. emase-producing strains included blaKPC (31,79.5%),blaVIM (13,33.3%) and blaNDM (12,30.8%).Efflux pump genes including AcrA (36,92.3%),AcrB(37,94.9%),TolC(35,89.7%),OqxA(30,76.9%),OqxB(30,76.9%),KdeA(38,97.4%),KpnE(38,97.4%),KetM(38,97.4%),RobA(37,94.9%),MarA(37,94.9%),RamA(36,92.3%),and KexD(25,64.1%) were detected. Fourteen strains were identified as carbapenem-re. sistant hypervirulent Klebsiella pneumoniae among twenty strains of Multidrug-resistant hypervirulent Klebsiella pneumoniae (MDR-hvKP),of which one carried blaKPC and blaNDM and six carried both blaKPC and blaVIM.Conclusions This study finds that many MDR-hvKP isolates carry a high frequency and diversity of antibiotic resistance genes and hypervirulence,among which carbapenem-resistant strains with hypervirulence also carry multiple efflux pumps. This will increase the difficulty of clinical diagnosis and treatment. |
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