产生超广谱β-内酰胺酶的肺炎克雷伯菌的药物敏感性及其基因型研究  

Antimicrobial Susceptibilities and Genotypes of Extended-spectrum β-lactamase Producing Klebsiella Pneumoniae

作　　者：付英梅[1] 张凤民[1] 张和光[2] 张文莉[1] 陈小贝[1] 赵月辉[1] 马佳毓[1] 

机构地区：[1]哈尔滨医科大学微生物学教研室,黑龙江省高校医学病原学重点实验室,150081 [2]哈尔滨医科大学附属第二医院检验科,150081

出　　处：《国际遗传学杂志》2007年第1期1-4,共4页International Journal of Genetics

基　　金：国家十五科技攻关项目（2004BA720A09-02）;黑龙江省卫生厅资助项目（2005-007）;致谢：感谢哈尔滨医科大学附属第二医院微生物室的郭微嫒教授、多立波副教授和齐桂云医师对本研究给与的支持和帮助.

摘　　要：目的研究产生超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌基因型及其药敏特征。方法对2003年12月～2004年12月哈尔滨地区临床分离的74株产ESBLs肺炎克雷伯菌，测定菌株对常用β-内酰胺类和非β-内酰胺类抗菌药物的敏感性，并采用SHV型和TEM型特异性引物检测ESBLs的基因型。结果产ESBLs细菌对头孢吡肟、氨曲南、阿米卡星和环丙沙星的敏感率依次为71．6％、20．3％、54．1％、31．1％，对头孢哌酮／舒巴坦的敏感率为54．1％，69株（93．2％）对亚胺培南敏感。74株产ESBLs细菌中携带blaSHV和6kTEM基因的阳性例数分别是45例（60．8％）和23例（31．1％）。结论哈尔滨地区产ESBLs肺炎克雷伯菌对常用β-内酰胺类和非β-内酰胺类抗菌药物的敏感性降低，临床上需慎用酶抑制剂复合物及第4代头孢菌素，亚胺培南仍是治疗产ESBLs菌感染的首选药物。产ESBLs肺炎克雷伯菌blaSHV的流行频率高于blaTEM.Objective To investigate the genotypes and antimicrobial susceptibilities of extended- spectrum β-lactamase（ESBL）-producing Klebsiella pneumoniae. Methods Antimicrobial susceptibilities to β- lactams and non-lactams of 74 strains of K. pneumoniae clinically isolated in the area of Harbin were determined, blaSHV and blaTEM were detected by specific PCR. Results Fifty-four percent of ESBL-producers were susceptible to cefoperazone/sulbactam, and 71.6%, 20. 3%, 54. 1% and 31.1% cefepine, aztreonam, amikacin and ciprofloxacin, respectively. Sixty-nine isolates （93.2%） were susceptible to imipenem. Strains carrying blaSHV and blaTEM were 45 （ 60. 8% ） and 23 （ 31. 1% ）, respectively. Conclusion ESBL-producing IC pneumoniae in the area of Harbin shows multi-drug resistance and decreases susceptibilities to the common β-lactams. Imipenem is the most active agent against the ESBL-producers. blaSHV is more prevalent than blaTEM.

关 键 词：肺炎克雷伯菌 超广谱Β-内酰胺酶 多重耐药 

分 类 号：R446[医药卫生—诊断学]