产超广谱β-内酰胺酶肺炎克雷伯菌(ESBLs-KP)临床分布特征和耐药机制研究

Study on Clinical Distribution Characteristics and Drug Resistance Mechanism of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae (ESBLs-KP)

摘要: 目的：本研究依托沂南县人民医院送检住院患者的不同样本，聚焦产超广谱β-内酰胺酶(Extended Spectrum Beta-Lactamases, ESBLs)的肺炎克雷伯菌(Klebsiella pneumoniae, KP)，系统分析其临床分布规律、耐药表现及耐药基因携带情况，旨在为本院临床诊疗中合理用药提供科学的参考价值。方法：2023年1月到2024年12月，回顾性收集沂南县人民医院住院患者各类标本中分离出的145株KP。通过标准化药敏试验与ESBLs表型确认实验双重验证，筛选出60株产ESBLs-KP菌株。采用SPSS21.0软件对比分析产ESBLs-KP与非产ESBLs-KP的耐药差异，同时借助PCR扩增技术，对产ESBLs-KP菌株的耐药基因进行检测。结果：1) 医院不同科室、不同标本中分离出145株KP中，产ESBLs-KP 60株，占比41.37%。同时，在标本来源方面，检出的产ESBLs-KP中，痰液最多，其次为尿液、血液，脓液占少量。在科室分布方面，检出的产ESBLs-KP中，ICU、急诊内科、呼吸内科排名前三。2) 药敏实验的结果，产ESBLs-KP对氨苄西林耐药率达100%，头孢唑林、头孢曲松耐药率分别为97%、93%，亚胺培南耐药率5%、阿米卡星耐药率2%、替加环素耐药率2%，且显著高于非产ESBLs-KP菌株。3) 耐药性基因检测结果，60株产ESBLs-KP菌株中，基因型TEM检出率为70%、SHV检出率为61.67% (多数耐药菌株携带1种或两种以上酰胺酶基因)，结论：1) 产ESBLs-KP检出的主要科室为ICU，急诊内科和呼吸内科，提醒临床医生对重点科应该加大关注，同时对多种耐药菌进行耐药性分析，表现出耐药情况非常的严峻，因此，应该更加重视重点科室对产ESBLs-KP的耐药性监测并合理的使用抗菌药物，减少耐药株产生。2) 通过产ESBLs-KP菌株耐药基因检测，结果表明该院耐药情况严重，尤其是耐药基因TEM、SHV检出率较高，因此提醒医生一定要注重合理应用抗生素，同时应该加大对科室耐药基因送检和对检测出耐药基因给予高度重视。

Abstract: Objective: This study focused on Klebsiella pneumoniae (KP) producing extended spectrum beta-lactamases (ESBLs), and systematically analyzed its clinical distribution, drug resistance performance and drug resistance gene carrier, aiming at providing scientific reference value for rational drug use in clinical diagnosis and treatment in our hospital. Methods: From January, 2023 to December, 2024, 145 strains of KP isolated from various specimens of inpatients in Yinan County People’s Hospital were collected retrospectively. 60 strains producing ESBLs-KP were screened out by double verification of standardized drug sensitivity test and ESBLs phenotype confirmation test. The difference in drug resistance between ESBLs-KP-producing and non-ESBLs-KP-producing strains was comparatively analyzed by SPSS21.0 software, and the drug resistance genes of ESBLs-KP-producing strains were detected by PCR amplification technology and the DNA sequencing method. Results: 1) Among 145 strains of KP isolated from different departments and specimens in the hospital, 60 strains produced ESBLs-KP, accounting for 41.37%. At the same time, in terms of specimen source, among the ESBLs-KP produced, sputum is the most, followed by urine, blood and pus. In terms of the distribution of departments, ICU, emergency medicine and respiratory medicine ranked the top three among the detected ESBLs-KP. 2) The results of the drug sensitivity test showed that the drug resistance rate of ESBLs-KP was 100% to ampicillin, 97% to cefazolin and 93% to ceftriaxone, 5% to imipenem, 2% to amikacin and 2% to tigecycline, which was significantly higher than that of non-esbls-KP strains. 3) The results of drug resistance gene detection showed that among 60 strains producing ESBLs-KP, the genotype TEM detection rate was 70% and the SHV detection rate was 61.67%. (Most drug-resistant strains carry one or more amidase genes) Conclusion: 1) The main departments that produce ESBLs-KP are ICU, emergency medicine and respiratory medicine, which reminds clinicians to pay more attention to key departments, and analyze the drug resistance of various drug-resistant bacteria, showing that the drug resistance situation is very severe. Therefore, more attention should be paid to the drug resistance monitoring of key departments and the rational use of antibacterial drugs to reduce the emergence of drug-resistant strains. 2) Through the detection of drug-resistant genes of ESBLs-KP-producing strains, the results show that the drug-resistant situation in our hospital is serious, especially the detection rate of drug-resistant genes TEM and SHV is high. Therefore, doctors should be reminded to pay attention to the rational use of antibiotics, and at the same time, they should increase the inspection of drug-resistant genes in departments and attach great importance to the detection of drug-resistant genes.