CAJ | 학술논문

目的探讨耐碳青霉烯类药物肺炎克雷伯菌的耐药机制.方法对南京地区两家三甲综合性医院的耐碳青霉烯抗菌药物肺炎克雷伯菌临床分离株,采用PCR方法对其40种β-内酰胺酶基因、膜孔蛋白编码基因及KPC-ISKpn6连锁进行检测,PCR阳性产物进行测序,测序结果BLAST对比分析.结果 24株耐碳青霉烯类药物肺炎克雷伯菌的A类β-内酰胺酶编码基因TEM-1及SHV的阳性检出率为100％ (24/24)、KPC-2的阳性检出率为95.8％ (23/24)、LAP-2的阳性检出率为45.8％ (11/24),C类β-内酰胺酶编码基因DHA的阳性检出率为4.2％ (1/24),KPC-ISKpn6连锁检测阳性率为95.8％ (23/24),膜孔蛋白编码基因ompK35与ompK36的突变率分别为95.8％ (23/24)及100％(24/24).结论本组肺炎克雷伯菌β-内酰胺酶TEM-1、SHV、KPC-2、LAP-2的携带率较高,其中KPC-2的高携带率及膜孔蛋白编码基因ompK35、ompK36的高突变率是本组肺炎克雷伯菌对碳青霉烯类抗菌药物耐药的主要机制；插入序列ISKpn6可能参与了KPC-2基因的介导.
목적 탐토내탄청매희류약물폐염극뢰백균적내약궤제.방법 대남경지구량가삼갑종합성의원적내탄청매희항균약물폐염극뢰백균림상분리주,채용PCR방법대기40충β-내선알매기인、막공단백편마기인급KPC-ISKpn6련쇄진행검측,PCR양성산물진행측서,측서결과BLAST대비분석.결과 24주내탄청매희류약물폐염극뢰백균적A류β-내선알매편마기인TEM-1급SHV적양성검출솔위100％ (24/24)、KPC-2적양성검출솔위95.8％ (23/24)、LAP-2적양성검출솔위45.8％ (11/24),C류β-내선알매편마기인DHA적양성검출솔위4.2％ (1/24),KPC-ISKpn6련쇄검측양성솔위95.8％ (23/24),막공단백편마기인ompK35여ompK36적돌변솔분별위95.8％ (23/24)급100％(24/24).결론 본조폐염극뢰백균β-내선알매TEM-1、SHV、KPC-2、LAP-2적휴대솔교고,기중KPC-2적고휴대솔급막공단백편마기인ompK35、ompK36적고돌변솔시본조폐염극뢰백균대탄청매희류항균약물내약적주요궤제；삽입서렬ISKpn6가능삼여료KPC-2기인적개도.
Objective To investigate the resistance-mechanism of the carbapenems-resistant Klebsiella pneumoniae isolated from clinical.Methods The clinical isolates of carbapenems-resistant Klebsiella pneumoniae from top three comprehensive hospitals of Nanjing area were examined by 40 beta-lactamase,porin-coding genes and linkage of KPC-ISKpn6 using PCR method,the PCR positive results were picked out for sequencing and sequencing BLAST search for comparison analysis.Results Twenty-four strains of carbapenems-resistant Klebsiella pneumoniae were detected,the positive rate of A beta-lactamase TEM-1 and SHV was 100％ (24/24),KPC-2 and LAP-2 was 95.8％ (23/24),45.8％ (11/24) respectively,and C beta-lactamase DHA was 4.2％ (1/24).Meanwhile,the positive detection rates of KPC-ISKpn6 linkage was 95.8％ (23/24),and the mutation rate of porin-coding genes ompK35 and ompK36 were up to 95.8％ (23/24) and 100％ (24/24).Conclusion High incidence of beta-lactamase TEM-1,SHV,KPC-2 and LAP-2 was found in the group of Klebsiella pneumoniae isolates,and carbapenems-resistant of which was primarily due to the high carrying rate of KPC-2 and the high mutation rate of porin-coding genes ompK35 and ompK36.The Insertion sequence ISKpn6 may be involved in the KPC-2 gene mediated-expression.