CAJ | 학술논문

目的：探讨产碳青霉烯酶肺炎克雷伯菌的耐药机制，为医院感染控制提供依据。方法法国 VITEK-2 Compact 对细菌进行鉴定和药敏试验；改良 Hodge 试验初筛肺炎克雷伯菌是否产碳青霉烯酶；多重 PCR 对菌株进行β-内酰胺类耐药基因和16S rRNA 甲基化酶基因的检测，测序确认基因型；多位点序列分型和脉冲场凝胶电泳实验进行细菌的同源性分析。结果5株肺炎克雷伯菌多位点序列分型是 ST11型，其中4株都同时携带有 blaKPC-2、blaTEM-1、blaCTXG 9和16S rRNA 甲基化酶 rmtB 基因，另外1株（HD03）肺炎克雷伯菌同时携带 blaNDM-1、blaKPC-2、blaDHA-1、blaTEM-1和 blaOXA-1基因。脉冲场凝胶电泳显示，除了 HD04菌株多一条带外，其余带型5株菌完全一致。结论经检索，肺炎克雷伯菌同时携带 blaNDM-1、blaKPC-2、blaDHA-1、blaTEM-1和 blaOXA-1基因为国内外首次报道，且该感染者无国外流行病学史。因此，要进一步加强对碳青霉烯类耐药的肠杆菌的医院感染控制和预防。
목적：탐토산탄청매희매폐염극뢰백균적내약궤제，위의원감염공제제공의거。방법법국 VITEK-2 Compact 대세균진행감정화약민시험；개량 Hodge 시험초사폐염극뢰백균시부산탄청매희매；다중 PCR 대균주진행β-내선알류내약기인화16S rRNA 갑기화매기인적검측，측서학인기인형；다위점서렬분형화맥충장응효전영실험진행세균적동원성분석。결과5주폐염극뢰백균다위점서렬분형시 ST11형，기중4주도동시휴대유 blaKPC-2、blaTEM-1、blaCTXG 9화16S rRNA 갑기화매 rmtB 기인，령외1주（HD03）폐염극뢰백균동시휴대 blaNDM-1、blaKPC-2、blaDHA-1、blaTEM-1화 blaOXA-1기인。맥충장응효전영현시，제료 HD04균주다일조대외，기여대형5주균완전일치。결론경검색，폐염극뢰백균동시휴대 blaNDM-1、blaKPC-2、blaDHA-1、blaTEM-1화 blaOXA-1기인위국내외수차보도，차해감염자무국외류행병학사。인차，요진일보가강대탄청매희류내약적장간균적의원감염공제화예방。
Objective To explore the molecular mechanism of the clinical carbapenem-resistant Klebsiella pneumon-iae isolates.Methods The strains identification and antibiotic susceptibilities were performed by VITEK-2 compact system.The genes of AmpC,ESBLs,MBL and KPCβ-lactamases were screened by specific PCR.And genotypes were confirmed by DNA sequencing.PFGE and multilocus sequence typing (MLST)were performed.Results 5 Klebsiella pneumoniae isolates were resistant to all antibiotics tested.Genotyping(PFGE)clustered 5 K .pneumoniae isolates into a single clonal type and MLST assigned them to sequence type 11.The blaKPC-2 ,baTEM-1 ,blaCTXG 9 and rmtB genes were present in four isolates.And Molecular testing verified the presence of blaNDM-1 ,blaKPC-2 ,blaDHA-1 ,blaTEM-1 and blaOXA-1 genes in a Klebsiella pneumoniae isolate.Conclusion To our knowledge,this is first report of coexistence of blaNDM-1 , blaKPC-2 ,blaDHA-1 ,blaTEM-1 and blaOXA-1 genes in a clinical Klebsiella pneumonia isolate.It may herald the emergence of a new pattern of drug resistance.Surveillance of metallo-β-lactamases in enterobacteriaceae is urgently needed to control and prevent the spread of these isolates.