CAJ | 학술논문

目的：了解上海交通大学医学院附属新华医院产KPC酶肺炎克雷伯菌的分布情况及分子流行病学特点，初步探讨其医院感染暴发流行的传播途径。方法连续收集2010年1月至2013年12月从上海新华医院临床样本中分离到的对碳青霉烯类抗菌药物耐药的肺炎克雷伯菌。采用Vitek 2 Compact系统联合纸片扩散法（ Kirby-Bauer法）对菌株进行鉴定及药敏试验，用改良Hodge试验对碳青霉烯类抗菌药物耐药的菌株进行耐药表型筛查，采用聚合酶链反应（ PCR）及测序方法检测碳青霉烯酶KPC基因，并对产KPC酶的菌株进行肠杆菌基因间重复共有序列（ ERIC）-PCR分型及临床资料汇总分析。结果共收集到77株对碳青霉烯类耐药的肺炎克雷伯菌，71株改良Hodge试验阳性，其中69株携带KPC基因，经测序确定为KPC-2基因。 ERIC-PCR结果提示69株产KPC-2酶菌株均为同一克隆株。12个科室首例分离到产KPC-2酶肺炎克雷伯菌的患者中，有7例在本院有转科记录，其中4例都曾在外科重症监护室（SICU）接受过治疗。结论上海新华医院的耐碳青霉烯类肺炎克雷伯菌以产KPC-2酶为主，这些菌株可能通过转科患者在院内形成广泛的水平播散。
목적：료해상해교통대학의학원부속신화의원산KPC매폐염극뢰백균적분포정황급분자류행병학특점，초보탐토기의원감염폭발류행적전파도경。방법련속수집2010년1월지2013년12월종상해신화의원림상양본중분리도적대탄청매희류항균약물내약적폐염극뢰백균。채용Vitek 2 Compact계통연합지편확산법（ Kirby-Bauer법）대균주진행감정급약민시험，용개량Hodge시험대탄청매희류항균약물내약적균주진행내약표형사사，채용취합매련반응（ PCR）급측서방법검측탄청매희매KPC기인，병대산KPC매적균주진행장간균기인간중복공유서렬（ ERIC）-PCR분형급림상자료회총분석。결과공수집도77주대탄청매희류내약적폐염극뢰백균，71주개량Hodge시험양성，기중69주휴대KPC기인，경측서학정위KPC-2기인。 ERIC-PCR결과제시69주산KPC-2매균주균위동일극륭주。12개과실수례분리도산KPC-2매폐염극뢰백균적환자중，유7례재본원유전과기록，기중4례도증재외과중증감호실（SICU）접수과치료。결론상해신화의원적내탄청매희류폐염극뢰백균이산KPC-2매위주，저사균주가능통과전과환자재원내형성엄범적수평파산。
Objective To investigate the prevalence and transmission route of Klebsiella pneumoniae carbapenemases ( KPC)-producing Klebsiella pneumoniae in Xinhua Hospital Affiliated to Shanghaijiao Tong University School of Medicine .Methods Carbapenem-resistant Klebsiella pneumoniae isolates from clinical samples were collected from Xinhua Hospital during January 2010 and December 2013.Vitek 2 Compact and disc diffusion method ( Kirby-Bauer method ) were used for identification of the strains and antibiotic susceptibility test . Modified Hodge test was performed for drug-resistant phenotype screening . Carbapenemase gene blaKPC was amplified by PCR, and the positive products were sequenced and analyzed . Enterobacterial repetitive intergenic consensus ( ERIC )-PCR was used to analyze molecular epidemiology of the KPC-producing strains .And clinical information of these isolates was analyzed .Results There were 77 carbapenem-resistant Klebsiella pneumoniae isolates in total , and 71 of them were positive in modified Hodge test.Sixty-nine isolates were identified carrying blaKPC-2 gene.All of the KPC-2-producing isolates were classified as the same genotype by ERIC-PCR. Among 12 patients with KPC-2-producing Klebsiella pneumoniae infection who were first identified in each departments , 7 were transferred from other departments, and 4 were treated in surgery intensive care unit (SICU).Conclusions Most of carbpenem-resistant Klebsiella pneumoniae strains isolated from Xinhua Hospital are KPC-2-producing .The outbreak of carbpenem-resistant Klebsiella pneumoniae infection in the hospital may be associated with the interdepartmental transfer of patients .