浙江省丽水地区发现1株泛耐药产<em>KPC</em>-2碳青霉烯酶的肺炎克雷伯菌

黄金伟; 李国雄; 余方友; 任建敏

doi:10.3784/j.issn.1003-9961.2011.01.018

浙江省丽水地区发现1株泛耐药产KPC-2碳青霉烯酶的肺炎克雷伯菌

doi: 10.3784/j.issn.1003-9961.2011.01.018

1.
丽水市中心医院检验科,浙江丽水 323000;
2.
温州医学院附属第一医院实验诊断中心

详细信息

作者简介:
黄金伟,男,浙江省丽水市人,主要从事细菌耐药性及感染性防治工作

通讯作者:
黄金伟,Tel:0578-2681463,Email:10111010062@fudan.edu.cn

中图分类号:
R563.1
计量
- 文章访问数: 1001
- HTML全文浏览量: 25
- PDF下载量: 546
- 被引次数: 0
出版历程
- 收稿日期: 2010-06-14
- 刊出日期: 2011-01-30

Detection of a strain of extensively drug resistant Klebsiella pneumoniae producing carbapenemase KPC-2 in Lishui, Zhejiang province

1.
Lishui Municipal Central Hospital, Lishui 323000, Zhejiang, China

摘要

摘要: 目的研究泛耐药肺炎克雷伯菌的相关耐药机制及初步探讨治疗对策。方法细菌鉴定采用Vitek-compact细菌鉴定系统,药敏实验采用K-B法,通过产碳青霉烯酶确证试验(Hodge实验)及聚合酶链反应(PCR)检测KPC-2基因,并进行序列测定。同时调查患者感染的诊疗情况。结果常规药敏实验显示除多粘菌素、米诺环素外全部耐药;增加磷霉素K-B法药敏实验显示抑菌环直径为20 mm,K-B法协同药敏实验显示多粘菌素、米诺环素、磷霉素、亚胺培南等均无协同抗菌活性;Hodge实验阳性,PCR检测到KPC-2基因,序列与GenBank AF297554序列一致。患者经拔除导尿管,入隔离病房,加强支持治疗后,1个月内未检查到泛耐药肺炎克雷伯菌。结论加强泛耐药肺炎克雷伯菌监测,提高对泛耐药菌的认识有助于感染疾病的治疗和预防。
- 泛耐药 /
- KPC-2碳青霉烯酶 /
- 肺炎克雷伯菌
Abstract: Objective To study the extensively drug resistant mechanisms of Klebsiella pneumoniae and discuss the clinical treatment strategies. Methods The isolate was identified by Vitek-compact system, the drug susceptibility test was conducted by K-B method, and KPC-2 gene was detected by Hodge test and polymerase chain reaction (PCR), then sequenced, and the treatment of the patient was investigated. Results The strain was resistant to all antibiotics used in routine drug susceptibility test except polymyxin and minocycline. The inhibition zone diameter of fosfomycin added later was 20mm. In synergistic drug susceptibility test, no synergistic antimicrobial activity was found between polymyxin, minocycline, fosfomycin and imipenem. Hodge test was positive; KPC-2 gene was detected by PCR and the sequence was consistent with AF297554 in GenBank. After treatment for one month, no extensively drug resistant Klebsiella pneumoniae strain was detected from the patients. Conclusion It is necessary to strengthen the monitoring of extensively drug resistant Klebsiella pneumoniae and improve the awareness of extensively drug resistant bacteria to facilitate the prevention and treatment of infectious disease.
- extensively drug resistance /
- carbapenemase KPC-2 /
- Klebsiella pneumoniae

HTML全文

参考文献(1)

[1]

[1] Wei ZQ,Chen YG,Yu YS,et al. Study on the epidemiology and β-lactamase-encoding genes of multiple-drug-resistant Klebsiella pneumoniae
[J].Chinese Journal of Laboratory Medicine,2002,25(6):329-332.( in Chinese) 魏泽庆,陈亚岗,俞云松,等.多重耐药肺炎克雷伯菌分子流行病学及β内酰胺酶基因型研究
[J].中华检验医学杂志,2002,25(6):329-332.

[2] Hu FP,Ye XY,Wu PC,et al. Surveillance of antibiotic resistance in clinical isolates from Shanghai Huashan Hospital in 2005
[J].Chinese Journal of Infection and Chemotherapy,2007,7(4):332-337. ( in Chinese) 胡付品,叶信予,吴培澄,等.2005年上海华山医院细菌耐药性监测
[J].中国感染与化疗杂志,2007,7(4):332-337.

[3] Hossain A,Ferraro MJ,Pino RM,et al. Plasmid-Mediated carbapenem-hydrolyzing enzyme KPC-2 in an Enterobacter sp
[J].Antimicrob Agents Chemother,2004,48(11):4438-4440.

[4] Yan JJ,KO WC,Wu JJ.Identification of a plasmid encoding SHV-2,TEM-1,and a variant of IMP-2 Metallo-β-lactamase,IMP-8,from a clinical isolate of Klebsiella pneumoniae
[J].Antimierob Agents Chemother,2001,45(8):2368-2371.

[5] Zhang R,Cai JC,Zhou HW,e al. Plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC-2 in an imipenem-resistant Serratia marcescens isolate
[J].Chinese Journal of Microbiology and Immunology,2007,27(8):623-624. ( in Chinese) 张嵘, 蔡加昌,周宏伟,等.对亚胺培南耐药粘质沙雷菌中质粒介导KPC-2型碳青霉烯酶的研究分析
[J].中华微生物学和免疫学杂志,2007,27(8):623-624.

[6] Endimiani A, Patel G, Hujer KM,et al.In vitro activity of fosfomycin against blaKPC-containing Klebsiella pneumoniae isolates, including those nonsusceptible to tigecycline and/or colistin
[J]. Antimicrob Agents Chemother,2004,54(1):526-529.