肺炎克雷伯菌超广谱β-内酰胺酶检测及耐药性分析  

Detection of extended-spectrum beta-lactamases and analysis of antibiotic resistance in clinical isolates of Klebsiella pneumoniae

作　　者：程训民[1] 张琪[1] 徐元宏[2] 李敏[1] 朱素珍[1] 沈继录[2] 

机构地区：[1]淮北市人民医院检验科,安徽淮北235000 [2]安徽医科大学第一医院检验科,安徽合肥230022

出　　处：《第四军医大学学报》2005年第19期1758-1760,共3页Journal of the Fourth Military Medical University

基　　金：安徽省卫生厅自然科研基金(2002A012);淮北市科技局科研基金(030131)

摘　　要：目的:了解产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的表型和基因分布及对常用抗生素的耐药情况.方法:用1999年NCCLS推荐的初筛试验从77株肺炎克雷伯菌中筛选出可疑产ESBLs细菌,并用确证试验加以确认;用PCR的方法扩增其基因型;用微量液体稀释法做药敏实验.结果:将初筛得到的可疑菌株用纸片扩散法确证,用头孢噻肟和头孢噻肟/克拉维酸测定,77株肺炎克雷伯菌中共检出45株产ESBLs(58.1%);而用头孢他啶和头孢他啶/克拉维酸检测ESBLs阳性菌为27株.PCR扩增基因型阳性结果为TEM型19株、SHV型8株、CTX-M型36株、OXA型11株.结论:近年来肺炎克雷伯菌产ESBLs率显著升高;基因型以CTX-M型为主,有些菌株同时携带多种耐药基因;亚胺培南仍为首选药物,头孢哌酮/舒巴坦、哌拉西林/他唑巴坦为候选药物.AIM： To study the phenotype and genotype distribution of extended-spectrum beta-lactamases （ESBLs ） -producing Klebsiella pneumoniae （ K. pneumoniae ） and its drug resistance. METHODS： Seventy-seven strains of K. pneumoniae were determined by 1999 NCCLs methods and the genotype of ESBLs was amplified by polymerase chain reaction （PCR）. The antibiotic susceptibility of bacteria was determined by microdilution. RESULTS： In the 77 positive K. pneumoniae isolates of the initial screen test, 45 strains （58.1% ） were confirmed by cefotaxime and cefotaxime-clavulanic acid but only 27 strains were confirmed by ceftazidime and ceftazidime-clavulanic acid. PCR showed that TEM, SHV, CTX-M or OXA-type ESBLs in the clinical strains were 19, 8, 36, 11 strains respectively. CONCLUSION： K. pneumoniae is one of the most common ESBLs-producing strains. The rates of ESBLs-producing K. pneumoniae significantly increase in recent years and CTX-M is most common genotype. Some strains carry two or more genotypes. Imipenem is the most susceptible antibiotic.

关 键 词：肺炎克雷伯菌 Β-内酰胺酶类 表型 基因型 耐药性 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]