Cetinkol Yeliz, Yildirim Arzu Altunçekiç, Telli Murat, Calgin Mustafa Kerem
Ordu University Faculty of Medicine, Medical Microbiology Department, Ordu, Turkey.
Ordu University Faculty of Medicine, Infectious Diseases Department, Ordu, Turkey.
Infez Med. 2016;24(1):48-53.
Infections due to carbapenem-resistant Klebsiella pneumoniae represent a growing problem nationally. In our study, we aimed to examine carbapenem-resistant K. pneumoniae with multiple resistance isolated in the intensive care unit of our hospital. Isolates were investigated for the presence of oxacillinase and metallo-beta lactamase genes with a view to determining the clonal relationship between the strains intensely over a short period. Strain identification was completed with conventional methods and automated identification kit. OXA-58, OXA-23, OXA-51, OXA-24 and OXA-48 and metallo-beta lactamase genes IPM, VIM, SPM, SIM, GIM and NDM-1 were investigated with PCR. For clonal relationships of carbapenem-resistant strains, the PFGE experiment was performed. While all of these carbapenem-resistant strains were positive for OXA-48, the resistant genes NDM-1, VIM, KPC, IPM, SPM, GIM, SIM, OXA-23, OXA-24, OXA-58 and OXA-51 were not observed. When molecular typing results were investigated, PFGE determined clonal distribution of three pulsotypes. However, it was observed that the strains intensified in a single clone and this was assessed as the outbreak isolate. The results of this study showed the primary enzyme responsible for carbapenem resistance in K. pneumoniae strains in our hospital is still OXA-48. To prevent the spread of carbapenem-resistant K. pneumoniae isolates, with epidemic potential, national-level monitoring and effective infection control precautions should be enforced.
耐碳青霉烯类肺炎克雷伯菌感染在全国范围内是一个日益严重的问题。在我们的研究中，我们旨在检测我院重症监护病房分离出的具有多重耐药性的耐碳青霉烯类肺炎克雷伯菌。对分离菌株进行了氧青霉烯酶和金属β-内酰胺酶基因检测，以便在短时间内深入确定菌株之间的克隆关系。采用传统方法和自动化鉴定试剂盒完成菌株鉴定。通过聚合酶链反应（PCR）检测OXA-58、OXA-23、OXA-51、OXA-24和OXA-48以及金属β-内酰胺酶基因IPM、VIM、SPM、SIM、GIM和NDM-1。对于耐碳青霉烯类菌株的克隆关系，进行了脉冲场凝胶电泳（PFGE）实验。虽然所有这些耐碳青霉烯类菌株的OXA-48均呈阳性，但未观察到耐药基因NDM-1、VIM、KPC、IPM、SPM、GIM、SIM、OXA-23、OXA-24、OXA-58和OXA-51。在研究分子分型结果时，PFGE确定了三种脉冲型的克隆分布。然而，观察到菌株在单一克隆中强化，这被评估为暴发分离株。本研究结果表明，我院肺炎克雷伯菌菌株中耐碳青霉烯类的主要酶仍然是OXA-48。为防止具有流行潜力的耐碳青霉烯类肺炎克雷伯菌分离株传播，应实施国家级监测和有效的感染控制措施。
