高产AmpC酶肺炎克雷伯菌的临床报道  

High AmpC-producing Clinical Isolates of Klebsiella pneumoniae:A Clinical Report

作　　者：管希周[1] 罗燕萍[1] 刘又宁[1] 沈定霞[1] 佘丹阳[1] 崔岩[1] 陈良安[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《中华医院感染学杂志》2004年第4期461-464,共4页Chinese Journal of Nosocomiology

摘　　要：的　对临床分离出的高产AmpC肺炎克雷伯菌分子生物学以及耐药特性进行研究。方法　对从临床分离的 1株头孢西丁高度耐药的肺炎克雷伯菌进行分析 ;用三维试验初步检测其高产AmpC ,然后用等电聚焦以及酶抑制试验等进行确认 ;用接合试验检验耐药基因的转移性 ,最后用E TEST法进行最小抑菌浓度 (MIC)测定。结果　该菌株三维试验为阳性 ,等电聚焦以及酶抑制试验表明 ,该菌株产一种等电点 (PI)为 7 8的能够被氯唑西林抑制而不能被克拉维酸抑制的 β 内酰胺酶 ;接合试验表明表达该 β 内酰胺酶的基因具有转移性 ,用E TEST法检测表明该菌株对环丙沙星、阿米卡星、青霉素类、酶抑制剂合剂及三代头孢菌素类均耐药 ,但它们对头孢吡肟、碳青酶烯类的亚胺培南和伊他培南均敏感。结论　我院临床分离肺炎克雷伯菌已经出现中高产AmpC菌株 ,其耐药性能够水平传播 ,并造成对多种三代头孢菌素及头孢西丁耐药 ,已经对临床的抗生素治疗带来重大威胁。OBJECTIVE To study the molecular biology and resistance character of high AmpC-producing clinical isolates of Klebsiella pneumoniae. METHODS A highly resistant to cefoxitin clinical isolate of K. pneumoniae was studied by three-dimensional method, isoelectric focusing(IEF) and conjugation experiment. Then the MIC of this strain was examined by E-stripe. RESULTS This isolate was initially screened as high AmpC-producing by three-dimensional method. And then, IEF found that this strain could produce a β-lactamase which PI was 7.8 and could be inhibited by cloxacillin but not by clavulanate. The conjugation experiment showed that the gene expressed this AmpC like β-lactamase could be transferable. The strain was resistant to ciprofloxacin, amikacin and most of penicillins, cephalosporins and β-lactams combined with the β-lactamase inhibitors. It was susceptible to cefepime, imipenem and etrapenem. CONCLUSIONS The high AmpC-producing K. pneumoniae could have been isolated in clinical strains in our hospital. It's AmpC gene can be transferred horizontally. It is resistant to many penicillins, cephalosporins and cefomycins and has brought us great menace in antibiotic therapy.

关 键 词：肺炎克雷伯菌 AMPC Β-内酰胺酶 

分 类 号：R378[医药卫生—病原生物学]