患者及相关环境分离CRKP的耐药谱与同源性

Antimicrobial resistance profile and homology of carbapenemresistant Klebsiella pneumoniae isolated from patients and related surroundings

摘要:

目的了解某医疗机构耐碳青霉烯类肺炎克雷伯菌（CRKP）感染患者临床分离株与环境分离株的同源性。方法收集该院1例患者分离的CRKP与该患者周围环境中检出的4例肺炎克雷伯菌，测定5株菌对临床上常用抗菌药物的敏感性，利用改良Hodge试验和CIM（Carbapenem Inactivation Method）试验检测5株菌产碳青霉烯酶情况，采用脉冲场凝胶电泳（PFGE）对其进行同源性分析。结果药敏试验结果显示，5株肺炎克雷伯菌（1株来自患者，4株来自于患者所在的病房环境，分离自护工手、溶液瓶口、升降扶手、床栏杆）除对头霉素类、氨基糖苷类抗生素的药敏结果不一致外，对其他各类抗菌药物均表现为耐药。改良Hodge试验和CIM试验证实5株菌均产碳青霉烯酶；PFGE结果显示，病房溶液瓶口、床栏杆、病床升降扶手同患者标本分离的CRKP电泳图谱一致，为同一菌株，而护工手同患者标本分离的CRKP电泳图谱有2条条带的差异，其菌株间有相近的关系。结论患者及其周围环境检出同一种CRKP，应严格执行医院感染控制制度，隔离感染患者，加强环境的清洁与消毒，避免医院感染暴发。

Abstract:

ObjectiveTo understand the homology of clinical isolates from patients with carbapenemresistant Klebsiella pneumoniae(CRKP) infection and isolates from environment in a medical institution. MethodsOne CRKP strain isolated from a patient in this hospital and 4 strains of Klebsiella pneumoniae(K. pneumoniae) isolated from patient’s surroundings were collected, susceptibility of 5 strains to commonly used antimicrobial agents was detected, production of carbapenems in 5 strains were detected by modified Hodge testing and carbapenem inactivation method（CIM）, homology analysis was performed by pulsedfield gel electrophoresis (PFGE). ResultsAntimicrobial susceptibility testing results showed that 5 strains of K. pneumoniae (1 from patient, 4 from the patient’s ward surroundings, including hands of nursing aides, solution bottle opening, handle for lifting and dropping bed, and bedrail) were all resistant to other antimicrobial agents except to cephamycin and aminoglycosides. The modified Hodge testing and CIM confirmed that 5 strains all produced carbapenemases; PFGE results showed that electrophoretogram of CRKP isolated from solution bottle opening of ward, bedrail, and handle for lifting and dropping bed were the same as CRKP isolated from patient, while electrophoretogram of CRKP isolated from hands of nursing aides had 2 different bands, there was a close relationship between the strains. ConclusionThe same type of CRKP were isolated from patient and his surroundings, it is necessary to implement healthcareassociated infection(HAI) control system, isolate infected patient, and strengthen environmental cleaning and disinfection, so as to avoid the outbreak of HAI.