本文選題：肺炎克雷伯菌 + 耐藥�。� 參考：《中華醫(yī)院感染學(xué)雜志》2017年16期

【摘要】：目的調(diào)查對(duì)常用抗菌藥物耐藥肺炎克雷伯菌(DRK)獲得性耐藥基因及相關(guān)可移動(dòng)遺傳元件的攜帶狀況及菌株間的親緣關(guān)系。方法 20株耐藥肺炎克雷伯菌均分離自醫(yī)院2015年1-12月住院患者痰標(biāo)本,用K-B法測定抗菌藥物的敏感性,采用聚合酶鏈反應(yīng)(PCR)及序列分析的方法分析24種β-內(nèi)酰胺類獲得性耐藥基因、11種氨基糖苷類獲得性耐藥基因、10種可移動(dòng)遺傳元件遺傳標(biāo)記,陽性耐藥基因測序后直接作BLAST比對(duì),耐藥基因檢測結(jié)果作樣本聚類分析(UPGMA法)。結(jié)果 20株耐藥肺炎克雷伯菌對(duì)β-內(nèi)酰胺類、氨基糖苷類、喹諾酮類均耐藥,但對(duì)碳青霉烯類均敏感;20株菌均檢出β-內(nèi)酰胺類獲得性耐藥基因,陽性率為100.0%,共檢出6種β-內(nèi)酰胺酶基因,blaDHA群基因檢出率為最高90.0%;每株也均檢出氨基糖苷類修飾酶基因,陽性率為100.0%,共檢出4種氨基糖苷類獲得性耐藥基因,ant(3″)-Ⅰ群基因檢出率為最高90.0%,但16SrRNA甲基化基因未檢出;可移動(dòng)遺傳元件標(biāo)記基因每株也均有檢出,共檢出7種可移動(dòng)遺傳元件標(biāo)記基因,其中tnp513、IS26、IS903、ISEcp1、intⅠ1陽性率均為100.0%,trbC陽性率95.0%;樣本聚類分析顯示,該組菌株有明顯的聚集性,分A與B二個(gè)群,B群又可分為B-1、B-2兩個(gè)亞群,B-2亞群存在二個(gè)克隆傳播,其中5-6號(hào)株均攜帶10種基因,4-7-8-9-13-14-15-16-17-18-19-20號(hào)株均攜帶9種基因。結(jié)論 20株耐藥肺炎克雷伯菌同時(shí)攜帶了β-內(nèi)酰胺類獲得性耐藥基因、氨基糖苷類修飾酶基因和可移動(dòng)遺傳元件標(biāo)記基因,是對(duì)β-內(nèi)酰胺類和氨基糖苷類產(chǎn)生耐藥的重要原因,該組菌檢出的2個(gè)克隆高度疑似醫(yī)院感染,同一克隆菌株攜帶相同基因。
[Abstract]:Objective to investigate the carrying status of the acquired resistance genes of Klebsiella pneumoniae (DRK) and related mobile genetic components and the relationship among the strains. Methods 20 strains of Klebsiella pneumoniae were isolated from hospital sputum specimens in hospital in 1-12 months of 2015, and the sensitivity of antibiotics was determined by K-B method. Enzyme chain reaction (PCR) and sequence analysis were used to analyze 24 beta lactam acquired resistance genes, 11 aminoglycoside resistant genes, 10 types of genetic markers for mobile genetic elements, direct BLAST alignment after sequencing of positive resistance genes, and cluster analysis of resistance gene detection results (UPGMA method). Results of 20 resistant pneumonia Klebsiella was resistant to beta lactam, aminoglycosides and quinolones, but was sensitive to carbapenems. 20 strains detected the beta lactam resistant gene, the positive rate was 100%, 6 beta lactamase genes were detected, and the detection rate of blaDHA group genes was the highest 90%. The rate of sex was 100%, and 4 aminoglycoside resistant genes were detected. The detection rate of ant (3 ") - I gene was the highest, but the 16SrRNA methylation gene was not detected. The mobile genetic element marker genes were detected and 7 kinds of movable genetic element markers were detected. The positive rates of tnp513, IS26, IS903, ISEcp1 and int i 1 were all positive. For 100%, the positive rate of trbC was 95%. Sample cluster analysis showed that the group had obvious aggregation, A and B two groups, and B group could be divided into B-1, B-2 two subgroups, B-2 subgroup with two clones, of which 10 genes were carried in 5-6 strains and 9 genes were carried in 4-7-8-9-13-14-15-16-17-18-19-20 strain. Conclusion 20 resistant pneumonia Klein Beta lactam acquired resistance gene, aminoglycoside modifying enzyme gene and movable genetic element marker gene were also carried by primary bacteria, which was an important cause of resistance to beta lactam and aminoglycosides. The 2 clones detected by the group were highly suspected of nosocomial infection and the same cloned strain carried the same gene.

【作者單位】： 孝感市中心醫(yī)院檢驗(yàn)科;武漢大學(xué)人民醫(yī)院檢驗(yàn)科;
【分類號(hào)】：R440

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本文編號(hào)：1788237