血培养分离碳青霉烯类耐药肺炎克雷伯菌临床分布和耐药基因分析

doi:10.3969/j.issn.1673-8640.2023.04.012

摘要/Abstract

摘要：

目的分析血培养分离的碳青霉烯类耐药肺炎克雷伯菌（CRKP）的临床分布和耐药基因特征，为临床合理用药提供参考。方法收集2010—2019年上海交通大学医学院附属新华医院血培养分离的非重复CRKP临床分离株153株。对153株CRKP进行多位点序列分型（MLST）和耐药基因检测。收集感染患者临床资料，分析CRKP临床分布特征。结果 2010—2019年，上海交通大学医学院附属新华医院血培养CRKP检出率呈上升趋势。有71.24%（109/153）的CRKP分离自重症监护病房（ICU）；成人患者占52.29%，主要为>60岁老年患者（72.50%）；儿童患者主要为≤1岁婴幼儿（64.38%）。有64.71%的感染患者治疗后痊愈出院。153株CRKP主要为ST11型（86.92%），患者集中在儿童ICU（29.32%）和外科ICU（18.80%）。碳青霉烯耐药基因筛查结果显示，153株CRKP中，有131株携带bla_KPC-2，11株携带bla_NDM-1，4株携带bla_NDM-5，7株未检测到碳青霉烯类耐药基因；131株携带bla_KPC-2的CRKP中，有129株（98.47%）为ST11型，检出率达84.31%（129/153）。同时携带bla_NDM-1和bla_NDM-5的CRKP均为非ST11型，感染对象主要为≤1岁的婴幼儿。结论上海交通大学医学院附属新华医院血培养CRKP检出率呈现上升趋势，主要集中在ICU，ST11型bla_KPC-2为主要的耐药基因型，临床应根据这一特征及时干预，合理用药。

关键词: 碳青霉烯类耐药肺炎克雷伯菌, 临床特征, 多位点序列分型, 耐药基因

Abstract:

Objective To analyze the clinical characteristics and drug resistance genes of carbapenem-resistant Klebsiella pneumoniae（CRKP） isolated from blood culturing，and to provide a reference for clinical antibiotic usage. Methods Totally，153 CRKP isolates from blood culturing in Xinhua Hospital of Shanghai Jiao Tong University School of Medicine from 2010 to 2019 were collected. Multilocus sequence typing（MLST） was carried out in the 153 CRKP isolates. The drug resistance genes of carbapenemase were determined. The clinical data were collected，and the clinical characteristics of CRKP were analyzed. Results The determination rate of CRKP showed a trend of increasing from 2010 to 2019. The 71.24%（109/153） CRKP were isolated from intensive care unit（ICU），and 52.29% of the patients were adults，which were >60 years old（72.50%）. Meanwhile，64.38% of the patients were infants ≤1 year old. The 64.71% of patients were discharged. According to the MLST results，86.92% CRKP（153 isolates） were ST11，29.32% of related patients were from pediatric ICU，and 18.80% were from surgery ICU. The carbapenem-resistant gene screening results showed that 131 isolates of CRKP carried bla_KPC-2，11 isolates carried bla_NDM-1，4 isolates bla_NDM-5，and the other 7 isolates had no carbapenem-resistant genes. The 129 of 131（98.47%） bla_KPC-2 carried CRKP were ST11，and the determination rate reached 84.31%（129/153）. Both bla_NDM-1 CRKP and bla_NDM-5 CRKP were non-ST11，and most of the related patients were infants ≤1 year old. Conclusions The determination rate of CRKP from blood culturing shows an increasing trend in Xinhua Hospital of Shanghai Jiao Tong University School of Medicine. The main drug resistance gene is ST11 bla_KPC-2，and the prevalence is mainly occurred in ICU.

Key words: Carbapenem-resistant Klebsiella pneumoniae, Clinical characteristic, Multilocus sequence typing, Drug resistance gene

中图分类号:

R446.1

王佳玮, 朱威南, 陈颖盈, 季萍, 王颖. 血培养分离碳青霉烯类耐药肺炎克雷伯菌临床分布和耐药基因分析[J]. 检验医学, 2023, 38(4): 362-367.

WANG Jiawei, ZHU Weinan, CHEN Yingying, JI Ping, WANG Ying. Clinical characteristics，molecular typing and drug resistance genes of carbapenem-resistant Klebsiella pneumoniae isolated from blood culturing[J]. Laboratory Medicine, 2023, 38(4): 362-367.

图/表 6

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年份	菌株数/株	百分比/%
2010年	1	0.65
2011年	2	1.31
2012年	1	0.65
2013年	4	2.61
2014年	9	5.88
2015年	9	5.88
2016年	23	15.03
2017年	33	21.57
2018年	39	25.49
2019年	32	20.92

年份	菌株数/株	百分比/%
2010年	1	0.65
2011年	2	1.31
2012年	1	0.65
2013年	4	2.61
2014年	9	5.88
2015年	9	5.88
2016年	23	15.03
2017年	33	21.57
2018年	39	25.49
2019年	32	20.92

病区	菌株数/株	百分比/%
儿童ICU	47	30.72
外科ICU	25	16.34
老年ICU	12	7.84
儿外科	12	7.84
新生儿ICU	10	6.54
脑外科ICU	9	5.88
普外科	8	5.23
急诊ICU	6	3.92
其他	24	15.69

病区	菌株数/株	百分比/%
儿童ICU	47	30.72
外科ICU	25	16.34
老年ICU	12	7.84
儿外科	12	7.84
新生儿ICU	10	6.54
脑外科ICU	9	5.88
普外科	8	5.23
急诊ICU	6	3.92
其他	24	15.69

临床特征	例数/例	百分比/%
性别
男	109	71.24
女	44	28.76
年龄
儿童	73	47.71
≤1岁	47	30.72
>1~7岁	25	16.34
>7~15岁	1	0.65
成人	80	52.29
16~60岁	22	14.38
>60岁	58	37.91
疾病类型
糖尿病	18	11.76
高血压	32	20.92
尿路感染	19	12.41
肺部感染	7	4.58
侵入性操作
机械通气	80	52.29
近期手术	121	79.08
置留导管	137	89.54
预后
痊愈	99	64.71
死亡	42	27.45
继续治疗	12	7.84