Molecular epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae

doi:10.3969/j.issn.1673-8640.2018.01.007

Abstract

Abstract:

： Objective To investigate the drug resistance and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae （CRKP） isolated from patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,and to provide a reference for clinical treatment and nosocomial infection control. Methods A total of 107 isolates of CRKP were collected from January 2013 to August 2015 in Renji Hospital. The susceptibilities of 107 CRKP isolates to 18 antimicrobial agents were determined by Kirby-Bauer disk diffusion method. The minimum inhibitory concentrations （MIC） of meropenem and tigecycline against 107 CRKP isolates were determined by microbroth dilution method. Carbapenem-resistant genes were determined by polymerase chain reaction （PCR）. The genotypes were identified by pulsed-field gel electrophoresis （PFGE）. Th. Results were analyzed by UPGMA clustering using NTSYS（2.1） software. Results The 107 CRKP isolates were susceptible to sulfamethoxazole （drug resistance rate 67.3%）,fosfomycin （drug resistance rate 24.0%） and tigecycline （drug resistance rate 100.0%） and were not susceptible to other 17 antimicrobial agents （drug resistance rate >95.0%）. KPC-2 gene was determined in all the 107 CRKP isolates. A total of 24 genotypes （A type-X type） were identified,and the 3 major genotypes were A type [19.6%（21/107）],B type [13.1%（14/107）] and C type [11.2%（12/107）]. There were 15 CRKP isolates of A type （15/21） collected within 1 month from departments of neurosurgery （6 isolates）,outpatient（3 isolates）,hematology （2 isolates）,geriatrics （2 isolates）,surgery intensive care unit （ICU）（1 isolate） and urology （1 isolate）. There were 4 CRKP isolates of F type （4/6） collected within 2 weeks from departments of general surgery （2 isolates） and geriatrics （2 isolates）. Other 22 genotypes were collected sporadically in different periods and different wards.Conclusions The major carbapenem-resistant gene of CRKP isolated from Renji Hospital is KPC-2. Outbreaks of A type and F type CRKP appear in Renji Hospital. CRKP isolates are susceptible to sulfamethoxazole,fosfomycin and tigecycline,and sulfamethoxazole is suggested as the first choice for treatment. Infection monitoring should be enhanced to reduce the spread of CRKP.

Key words: Carbapenem-resistant Klebsiella pneumoniae, Genotype, Pulsed-field gel electrophoresis

CLC Number:

R446.5

SHI Weiyang, LIU Yang, HAN Yichao, ZHENG Dandan, DAI Erkuan, ZHENG Bing, LI Min. Molecular epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae[J]. Laboratory Medicine, 2018, 33(1): 37-43.

Figures/Tables 5

References 19

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基因	引物名称	引物序列（5'~3'）	产物大小（bp）
A类碳青霉烯酶基因
bla_KPC_-2	KPC-2F	GCTACACCTAGCTCCACCTTC	989
bla_KPC_-2	KPC-2R	ACAGTGGTTGGTAATCCATGC	989
bla_OXA_-48	OXA48-F	TTGGTGGCATCGATTATCGG	744
bla_OXA_-48	OXA48-R	GAGCACTTCTTTTGTGATGGC	744
B类碳青霉烯酶（金属酶）基因
bla_VIM_-1	VIM-1F	AGTGGTGAGTATCCGACAG	261
bla_VIM_-1	VIM-1R	ATGAAAGTGCGTGGAGAC	261
bla_VIM_-2	VIM-2F	ATGTTCAAACTTTTGAGTAAG	801
bla_VIM_-2	VIM-2R	CTACTCAACGACTGAGCG	801
bla_IMP_-1	IMP-1F IMP-1R	CTACCGCAGCAGAGTCTTTG	587
bla_IMP_-1	IMP-1F IMP-1R	AACCAGTTTTGCCTTACCAT	587
bla_IMP_-2	IMP-2F IMP-2R	GTTTTATGTGTATGCTTCC	678
bla_IMP_-2	IMP-2F IMP-2R	AGCCTGTTCCCATGTAC	678
bla_NDM_-1	NDM-1F	CTTCCAACGGTTTGATCGTC	271
bla_NDM_-1	NDM-1R	ATTGGCATAAGTCGCAATCC	271

基因	引物名称	引物序列（5'~3'）	产物大小（bp）
A类碳青霉烯酶基因
bla_KPC_-2	KPC-2F	GCTACACCTAGCTCCACCTTC	989
bla_KPC_-2	KPC-2R	ACAGTGGTTGGTAATCCATGC	989
bla_OXA_-48	OXA48-F	TTGGTGGCATCGATTATCGG	744
bla_OXA_-48	OXA48-R	GAGCACTTCTTTTGTGATGGC	744
B类碳青霉烯酶（金属酶）基因
bla_VIM_-1	VIM-1F	AGTGGTGAGTATCCGACAG	261
bla_VIM_-1	VIM-1R	ATGAAAGTGCGTGGAGAC	261
bla_VIM_-2	VIM-2F	ATGTTCAAACTTTTGAGTAAG	801
bla_VIM_-2	VIM-2R	CTACTCAACGACTGAGCG	801
bla_IMP_-1	IMP-1F IMP-1R	CTACCGCAGCAGAGTCTTTG	587
bla_IMP_-1	IMP-1F IMP-1R	AACCAGTTTTGCCTTACCAT	587
bla_IMP_-2	IMP-2F IMP-2R	GTTTTATGTGTATGCTTCC	678
bla_IMP_-2	IMP-2F IMP-2R	AGCCTGTTCCCATGTAC	678
bla_NDM_-1	NDM-1F	CTTCCAACGGTTTGATCGTC	271
bla_NDM_-1	NDM-1R	ATTGGCATAAGTCGCAATCC	271

病区	株数（%）	PFGE分型（株）
病区	株数（%）	A型	B型	C型	D~X型
神经外科	20（18.7）	8	4	2	6
外科ICU	20（18.7）	1	2	3	14
普外科	17（15.9）	0	1	2	14
老年科	15（14.0）	3	1	1	10
急诊内科留观室	14（13.1）	1	4	2	7
门诊	10（9.4）	3	1	0	6
血液科	5（4.7）	3	0	2	0
肾内科	2（1.9）	0	1	0	1
泌尿外科	1（0.9）	1	0	0	0
妇产科	1（0.9）	1	0	0	0
肝移植科	1（0.9）	0	0	0	1
呼吸科	1（0.9）	0	0	0	1

病区	株数（%）	PFGE分型（株）
病区	株数（%）	A型	B型	C型	D~X型
神经外科	20（18.7）	8	4	2	6
外科ICU	20（18.7）	1	2	3	14
普外科	17（15.9）	0	1	2	14
老年科	15（14.0）	3	1	1	10
急诊内科留观室	14（13.1）	1	4	2	7
门诊	10（9.4）	3	1	0	6
血液科	5（4.7）	3	0	2	0
肾内科	2（1.9）	0	1	0	1
泌尿外科	1（0.9）	1	0	0	0
妇产科	1（0.9）	1	0	0	0
肝移植科	1（0.9）	0	0	0	1
呼吸科	1（0.9）	0	0	0	1