肺炎克雷伯菌与植生克雷伯菌喹诺酮类耐药基因研究  

quinolones resistance genes in multi-drug resistant klebsiella pneumonia and klebsiella planticola

作　　者：虞亦鸣[1] 马红映[1] 裘莉佩[2] 励旭光[3] 吕婉飞[4] 汪丽[4] 颜碧清[3] 邓在春[1] 

机构地区：[1]宁波大学医学院附属医院呼吸科,315020 [2]宁波市医疗中心李惠利医院微生物学科 [3]宁波大学医学院附属医院重症监护室,315020 [4]宁波大学医学院附属医院临床微生物学科,315020

出　　处：《中华临床感染病杂志》2012年第2期65-68,共4页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的 分析宁波大学医学院附属医院克雷伯菌属的耐药性及其对喹喏酮类药物的耐药机制.方法 收集2009年10月-2011年3月分离出的20株克雷伯菌属菌株,经鉴定确认18株为肺炎克雷伯菌,2株为植生克雷伯菌.采用k-b纸片扩散法检测其对药物的敏感性.pcr法检测染色体介导的gyra、parc基因和质粒介导的aac(6’)-Ⅰ b-cr、qnra、qnrb、qnrs、qepa基因,pcr阳性产物采用pcr直接全自动荧光法测序.结果 20株克雷伯菌属菌对β-内酰胺类、氨基糖苷类、喹诺酮类抗菌药物均表现为多重耐药性(耐药率均在80％以上),其中植生克雷伯菌对亚胺培南和美罗培南敏感.18株(90％)菌株存在gyra、parc基因突变；aac(6’)-Ⅰ b-cr阳性12株(60％),qnrb和qnrs阳性均为4株(20％).结论 本组20株克雷伯菌属菌对喹诺酮类药物耐药主要与gyra和parc基因突变相关.objective to investigate the multi-drug resistance of klebsiella strains and its mechanism.methods twenty strains of klebsiella were isolated from the affiliated hospital of medical college,ningbo university from october 2009 to march 2011,in which 18 isolates were klebsiella pneumonia and 2 were klebsiella planticola. drug sensitivity was determined by k-b tests. drug resistant genes gyra,parc (chromosome mediated) and aac( 6′)-i b-cr,qnra,qnrb,qnrs,qepa (plasmid mediated) were amplified by pcr and verified by direct automated fluorogenic sequencing. results resistance to β-1actams,aminoglycosides and quinolones was observed in 20 strains,and resistant rates were all above 80％.klebsiella planticola strains were sensitive to imipenem and meropenem.mutations of gyra and parc genes existed in 18 strains (90％),and the positive rates of aac (6') -i b-c r,qnrb and qnrs were 60％ (12/20),20％ (4/20) and 20％ (4/20),respectively.conclusion the mutations ofgyra and parc genes may be the main cause of the resistance to quinolones in these strains.

关 键 词：克雷伯菌 肺炎 植生克雷伯菌 喹喏酮类 抗药性 基因 

分 类 号：R446.5[医药卫生—诊断学]