文章摘要
陆颖,王春.肺炎克雷伯菌的耐药性和毒力分析以及外排泵的分布特点研究[J].安徽医药,待发表.
肺炎克雷伯菌的耐药性和毒力分析以及外排泵的分布特点研究
投稿时间:2024-04-23  录用日期:2024-06-08
DOI:
中文关键词: 肺炎克雷伯菌,耐药性,毒力,外排泵
英文关键词: 
基金项目:安徽省教育厅自然科学重点研究项目(2022AH051456,KJ2021A0696)
作者单位邮编
陆颖 上海市第一人民医院蚌埠医院(蚌埠医科大学第二附属医院) 233000
王春* 上海市第一人民医院蚌埠医院(蚌埠医科大学第二附属医院) 
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中文摘要:
      目的 分析肺炎克雷伯菌的耐药性和毒力以及外排泵的分布特点,为临床合理使用抗菌药物提供参考。方法 本研究收集某医院2018年8月至2022年3月分离的120株非重复肺炎克雷伯菌株,采用微量肉汤稀释法检测抗菌药物的最低抑菌浓度,DDST及mCIM试验分别检测ESBLs和碳青霉烯酶,拉丝试验进行高黏液表型检测,PCR检测耐药基因及外排泵。结果 cKP对氨苄西林/舒巴坦、头孢唑啉、头孢曲松、庆大霉素、妥布霉素、甲氧苄啶/磺胺甲噁唑的耐药性明显高于hvKP。cKP中的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(97.4%)和blaTEM(63.2%)。39株产碳青霉烯酶菌株中,检测出耐药基因包括blaKPC(79.5%),blaVIM(33.3%)以及blaNDM(30.8%);外排泵基因包括AcrA(92.3%)、AcrB(94.9%)、TolC(89.7%)、OqxA(76.9%)、OqxB(76.9%)、KdeA(97.4%)、KpnE(97.4%)、KetM(97.4%)、RobA(94.9%)、MarA(94.9%)、RamA(92.3%)以及KexD(64.1%)。20株MDR-hvKP菌株中,14株为CR-hvKP。其中,1株携带blaKPC和blaNDM,6株同时携带blaKPC和blaVIM。结论 本研究发现多株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。这将增加了临床诊断和治疗的难度。
英文摘要:
      Objective The antibiotic resistance and virulence of Klebsiella pneumoniae and distribution characteristics of efflux pumps were analyzed to provide reference for rational use of antibiotics in clinical practice. Methods:A total of 120 non-repeated Klebsiella pneumoniae from August 2018 to March 2022 were collected in a certain hospital. The minimal inhibitory concentration of antibiotic were tested by the broth microdilution method, and the positive strains producing ESBLs and carbapenemase were detected by DDST and mCIM respectively. The hypermucoviscous phenotype of the strain was tested by the string test. PCR was performed to detect the antibiotic resistance genes and efflux pumps. Results:The resistance of cKP to ampicillin/sulbactam, cefazolin, ceftriaxone, gentamicin, tobramycin, and trimethoprim/sulfamethoxazole was significantly higher than that of hvKP. MDR and ESBLs positive strains in cKP were significantly higher than those in hvKP(P<0.05). However, there was no significant difference between carbapenemases-producing strains in hvKP and cKP. Among the MDR isolates, thirty-eight ESBLs-producing strains carried blaCTX-M. followed by blaSHV(97.4%) and blaTEM(63.2%). Drug resistance genes were detected in thirty-nine carbapenemase-producing strains included blaKPC(79.5%), blaVIM(33.3%) and blaNDM(30.8%). Efflux pump genes including AcrA(92.3%), AcrB(94.9%), TolC(89.7%), OqxA(76.9%), OqxB(76.9%), KdeA(97.4%), KpnE(97.4%), KetM(97.4%), RobA(94.9%), MarA(94.9%), RamA(92.3%), and KexD(64.1%) were detected. Fourteen strains were identified as CR-hvKP among twenty strains of MDR-hvKP, of which one carried blaKPC and blaNDM and six carried both blaKPC and blaVIM. Conclusion: In this study, it was found that many MDR-hvKP isolates carried a high frequency and diversity of antibiotic resistance genes and hypervirulence, among which carbapenem-resistant strains with hypervirulence also carried multiple efflux pumps.This will increase the difficulty of clinical diagnosis and treatment.
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