碳青霉烯类耐药肺炎克雷伯菌基因型检测及同源性分析

目的了解福建医科大学附属第一医院耐碳青霉烯类肺炎克雷伯菌（KPC）的耐药基因分型及同源性分布情况。方法收集临床分离的29株KPC，改良Hodge试验检测碳青霉烯酶表型。PCR检测碳青霉烯酶blaKPC、blaIMP-1、blaVIM-1、blaOXA-48及blaNDM-基因；阳性结果进行DNA测序，并进行BLAST比对确定其基因型。采用肠杆菌科基因间重复序列（ERIC—PCR）对KPC进行同源性分析。结果29株KPC中Hodge试验阳性27株，阳性率为93．1％（27／29）。PCR扩增和DNA测序显示28株为blaKPC-2,株为blaIMP-1,未检出blaVIM-2、blaOXA-48和blaNDM-1基因。同源性分析发现KPC主要存在两种型别：28株A1和1株A2。结论blaKPC-2型碳青霉烯酶是该院KPC的主要型别，A1型已在该院流行，应加强院感监测和预防。ERIC—PCR是一种简便、快捷的基因分型技术，适合同源性的初步分型筛查。

Analysis genotype and homology of carbapenems-resistant Klebsiella pneumoniae

Objective To investigate the genotyping and homology of carbapenems-resistant Klebsiella pneumoniae （KPC） isolated from clinical specimens of our hospital. Methods 29 clinical isolated of KPC were isolated from clinical specimens. The carbapenemase phenotypes were confirmed by modified Hodge test. The blaKPC, blaIMP-1 , blaVIM-1 ,blaOXA-48 and blaNDM-1 genes of carbapenemase were detected by PCR, and the obtained positive products were performed DNA sequencing. The genotype was determined by BLAST contrast. The homology of the 29 strains was analyzed by enterobacterial repetitive intergenic consensus-PCR（ERIC-PCR）. Results There were 27 of 29 KPC strains appeard positive response of modified Hodge test. The 28 of blaKPC-2 gene was identified by PCR and DNA sequencing, also had 1 of blaIMP-1. The blaVIM-2 , blaNDM-1 and blaOXA-48 genes were not detected. The result of ERIC-PCR showed that only 2 genotype of KPC. Conclusion The blaKPC-2 is the major genotypes of KPC, and had been clonal spread of KPC among patients in the hospital. The ERIC-PCR is a useful and expeditious method for preliminary screen genotyping of KPC.