广西医学

目的分析外科ICU和内科ICU碳青霉烯耐药肺炎克雷伯菌（CRKP）的耐药性、常见的碳青霉烯酶基因及菌株之间的亲缘性关系。方法收集2019年1月至2020年12月从某三甲医院外科ICU和内科ICU分离鉴定的CRKP非重复菌株，采用自动仪器法对菌株进行药物敏感性试验；采用mCIM联合eCIM试验进行碳青霉烯酶表型检测，并通过PCR技术联合DNA测序检测碳青霉烯酶基因；利用多位点序列分型（MLST）方法对碳青霉烯酶阳性菌株进行同源性分析。结果共收集15株CRKP菌株，其中外科ICU 8株，内科ICU 7株。CRKP菌株对临床多数抗菌药物表现高耐药性，仅对替加环素表现较高敏感性。mCIM联合eCIM试验并经PCR验证，共有14株CRKP携带碳青霉烯酶基因，其中7株单纯携带KPC⁃2基因，主要来源于内科ICU；5株单纯携带NDM⁃5基因，来源于外科ICU；1株携带KPC⁃2基因合并少见金属酶基因来源于内科ICU；1株携带NDM⁃1基因合并OXA⁃181基因来源于外科ICU。MLST结果显示，医院ICU分离的CRKP菌株为ST11、ST15、ST16 3个序列型别。内科ICU优势序列为ST11（6/6），全部携带KPC⁃2基因；外科ICU优势序列为ST15（5/8），主要携带NDM⁃5基因。结论医院外科ICU和内科ICU分离的CRKP菌株耐药性高，其携带的耐药基因和优势流行菌株存在差异。应加强多重耐药菌的监测及流行病学研究，及时采取有效治疗方案和防控策略，防止耐药菌株产生和流行播散。

Objective To analyze the kinship relation between carbapenem⁃resistant Klebsiella pneumoniae (CRKP) drug resistance, common carbapenemase genes and their strains in Surgical ICU versus Medical ICU. Methods CRKP non⁃duplicate strains isolated and validated in Surgical ICU and Medical ICU of a class Ⅲ hospital from January 2019 to December 2020 were collected, and drug sensitivity test was performed on strains by employing automatic instrument method. The carbapenemase phenotype was detected by using the mCIM combined with eCIM test, and the carbapenemase genes were detected through the PCR technique combined with DNA sequencing. The homology analysis was performed on carbapenemase⁃positive strains by the application of the multilocus sequence typing (MLST) method. Results A total of 15 strains of CRKP were collected, therein there were 8 strains in Surgical ICU and 7 strains in Medical ICU. CRKP strains exhibited high drug resistance to most clinical antibacterial agents, and only maintained high sensitivity to tigecycline. Through mCIM combined with eCIM test and PCR validation, a total of 14 CRKP strains carried carbapenemase genes, of which 7 strains only carried KPC⁃2 gene, mainly from Medical ICU, and 5 strains only carried NDM⁃5 gene, which were from Surgical ICU. One strain carrying KPC⁃2 gene and concomitant rare metalloenzyme gene was from Medical ICU, and one strain carrying NDM⁃1 gene and concomitant OXA⁃181 gene was derived from Surgical ICU. The results of MLST revealed that CRKP strains isolated from ICU of hospital were 3 sequence types of ST11, ST15, and ST16. The dominant sequence of Medical ICU was ST11 (6/6), all carrying KPC⁃2 gene, and the dominant sequence of Surgical ICU was ST15 (5/8), mainly carrying NDM⁃5 gene. Conclusion CRKP strains isolated from Surgical ICU and Medical ICU in hospital exert high drug resistance, and there are differences in drug resistance genes and dominant epidemic strains carried by CRKP strains. It is necessary to strengthen surveillance and epidemiological study of multidrug⁃resistant bacteria, and timely adopt effective treatment regimen and prevention and control strategies to prevent emergence and spread of drug⁃resistant strains.