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目的了解血流感染肺炎克雷伯菌的耐药机制及其耐药传播机制,为临床医院感染控制提供理论依据。方法收集南昌大学第一附属医院2012年3月至2013年9月住院患者的血液培养标本中分离获得的肺炎克雷伯菌86株,应用PCR扩增方法检测耐药基因,MLST和质粒接合试验分析其耐药传播方式。结果超广谱β-内酰胺酶基因中有26株KPC基因阳性,2株IMP基因阳性,4株VIM基因阳性,1株NDM-1基因阳性;整合子基因中有4株int基因阳性,int基因阳性的4株整合子可变区基因均为阳性;氨基糖苷类耐药基因中有22株acc6′-Ib基因阳性;喹诺酮类耐药基因中有48株qnrA基因阳性,20株qnrS基因阳性,8株qnrB基因阳性。MLST结果显示34株(39.5%)为ST395型,是主要基因型。氨基糖苷类耐药基因阳性菌株接合成功7株;喹诺酮类耐药基因阳性菌株接合成功15株。结论血流感染肺炎克雷伯菌主要以携带耐碳青霉烯酶基因和耐喹诺酮类基因为主,耐药传播机制多种,包括克隆传播和质粒介导传播。
Objective To understand the mechanism of drug resistance and drug-resistant transmission of Klebsiella pneumoniae in bloodstream infection and provide a theoretical basis for the control of clinical nosocomial infection. Methods Eighty-six strains of Klebsiella pneumoniae were isolated from the blood culture specimens of hospitalized patients in the First Affiliated Hospital of Nanchang University from March 2012 to September 2013. The resistant gene, MLST and plasmid conjugation test were detected by PCR amplification Analysis of its resistance to transmission. Results There were 26 KPC genes, 2 IMP genes, 4 VIM genes and 1 NDM-1 gene in the extended-spectrum β-lactamase gene; 4 int genes were positive in the integron genes, int Among the four aminoglycoside resistance genes, 22 acc6’-Ib genes were positive; 48 quinolone resistance genes were positive for qnrA gene and 20 were qnrS gene positive , 8 qnrB gene positive. MLST results showed that 34 strains (39.5%) were ST395, which was the main genotype. Seven aminoglycoside resistance positive strains were successfully joined and fifteen strains were successfully linked with quinolone resistance gene positive strains. Conclusions Klebsiella pneumoniae is mainly infected with carbapenemase-resistance gene and quinolone-resistant gene, and has a variety of drug-resistant transmission mechanisms, including cloning and plasmid-mediated transmission.