下诺夫哥罗德市医院肺炎克雷伯菌临床分离株耐药表型及遗传特征分析

N. Gordinskaya, E. V. Boriskina, D. Kryazhev
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引用次数: 1

摘要

目标。目的研究下诺夫哥罗德市肺炎克雷伯菌临床分离株体外抗微生物药物耐药性及临床最重要的碳青霉烯酶基因的流行情况。材料与方法。本研究共检测了238例临床分离的肺炎克雷伯菌,分别来自上、下呼吸道、腹腔、泌尿生殖道和伤口分泌物。物种鉴定采用WalkAway 96分析仪(德国西门子公司),POS Combo Type 20片(美国贝克曼库尔特公司)和Multiscan FC分光光度计(芬兰Thermo Scientific公司),Microlatest片(捷克PLIVA-Lachema公司)。采用扩散法和微生物分析仪WalkAway 96 (Siemens, Germany)进行耐药性测定。使用“MIC粘菌素”试剂盒(Erba Mannheim,捷克共和国)测定粘菌素的最低抑制浓度。RT-PCR检测碳青霉烯酶基因(KPC, OXA-48组,IMP, VIM和NDM),采用CFX-96机器(Bio-Rad,美国)和商业试剂盒“MDR KPC/OXA-48- fl”和“MDR MBL-FL”(AmpliSens,俄罗斯)。下诺夫哥罗德市肺炎克雷伯菌分离株对III-V代头孢菌素耐药率超过90%,对庆大霉素耐药率为53.8%,对环丙沙星耐药率为71.2%,对复方新诺明耐药率为81.2%,对埃他培南耐药率为88.1%,对多利培南耐药率为37.1%,对亚胺培南耐药率为21.6%,对美罗培南耐药率为34.3%,对粘菌素耐药率为3.2%。13.1%的分离株中检出КРС-like碳青霉烯酶基因,21.6%检出OХA-48 -基因。在检测的分离物中未发现金属β -内酰胺酶。目前,下诺夫哥罗德没有对所有肺炎克雷伯菌分离株有效的抗菌剂。碳青霉烯类和多粘菌素对50%以上的分离株仍有活性。
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Phenotypic and genetic characteristics of antimicrobial resistance of Klebsiella pneumoniae clinical isolates in hospitals of Nizhny Novgorod
Objective. To study in vitro antimicrobial resistance and prevalence of the most clinically important carbapenemases genes in Klebsiella pneumoniae clinical isolates in Nizhny Novgorod. Materials and Methods. A total of 238 K. pneumoniae clinical isolates from upper and lower respiratory tracts, abdominal cavity, urogenital tract, and wound discharge were tested in this study. Species identification was done using WalkAway 96 analyzer (Siemens, Germany) with POS Combo Type 20 tablets (Beckman Coulter, USA) and Multiscan FC spectrophotometer (Thermo Scientific, Finland) with Microlatest tablets (PLIVA-Lachema, Czech Republic). Antimicrobial resistance was determined by discdiffusion method and using microbiological analyzer WalkAway 96 (Siemens, Germany). Minimal inhibitory concentrations for colistin were determined using the “MIC Colistin” kit (Erba Mannheim, Czech Republic). Detection of carbapenemases genes (KPC, OXA-48 group, IMP, VIM and NDM) was performed by RT-PCR using CFX-96 machine (Bio-Rad, USA) and commercial kits «MDR KPC/OXA-48-FL» and «MDR MBL-FL» (AmpliSens, Russia). Results. More than 90% of K. pneumoniae isolates in Nizhny Novgorod were resistant to III–V generation cephalosporins, 53.8% – to gentamicin, 71.2% – to ciprofloxacin, 81.2% – to co-trimoxazole, 88.1% – to ertapenem, 37.1% – to doripenem, 21.6% – to imipenem, 34.3% – to meropenem, 3.2% – to colistin. Genes of КРС-like carbapenemases were detected in 13.1% of isolates, OХA-48 – in 21.6%. Metallobeta-lactamases were not identified among tested isolates. Conclusions. Currently, there are no antimicrobials that active against all K. pneumoniae isolates in Nizhny Novgorod. Carbapenems and polymyxins remain active against more than 50% of isolates.
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