烧伤患者感染产超广谱β-内酰胺酶肺炎克雷伯菌检测及质粒图谱分析  

Detection and Plasmid Profile Analysis of ESBLs-producing Klebsiella pneumoniae in Burn Patients

作　　者：李平[1] 董振芳[1] 于行堂[2] 白雪丽[1] 宋晓斐[1] 

机构地区：[1]山东省立医院,山东济南250021 [2]山东文登中心医院,山东文登264400

出　　处：《中华医院感染学杂志》2007年第4期382-384,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨肺炎克雷伯菌致烧伤患者感染的生物学和分子生物学特点,为寻找传染源、切断传播途径,有的放矢预防和控制医院感染提供第一手资料。方法用法国生物梅里埃公司ATB Expression仪鉴定;K-B法进行耐药性检测;Alkaline Lysis小量快速提取质粒DNA,凝胶电泳拍照;NCCLS推荐产超广谱β-内酰胺酶(ESBLs)检测法。结果烧伤患者和环境检测的肺炎克雷伯菌除对CIP、FOX和IMP敏感外,对其他12种抗菌药物均耐药;质粒DNA图谱显示有3条质粒带,相对分子质量约为4.7×106、3.6×106和2.0×106;ESBLs肺炎克雷伯菌,与对照菌特性不同;同时检出原发感染金黄色葡萄球菌、酿脓链球菌和铜绿假单胞菌。结论此次烧伤患者感染流行的病原菌为ESBLs肺炎克雷伯菌,其耐药谱和质粒DNA图谱相同,属同源菌,传播途径可能为病历夹和门把手,提示医院环境应加强消毒管理、杜绝传染源、切断传播途径,控制和减少医院感染。OBJECTIVE To investigate the biological and molecular biological characteristics of Klebsiella pneumoniae in burn patients in order to give the first hand information for preventing and controlling of hospital acquired infections. METHODS The identification was done by Bio-Merieux ATB expression. Antimicrobial susceptibility test was performed with K-B method. The plasmid DNA was extracted by Alkaline Lysis, and separated by electrophoresis on the gel. The ESBLs detection was based on NCCLS. RESULTS The K. pneumoniae from the burn patients and the environment were sensitive to CIP, FOX and IPM, but showed resistance to the rest 12 antibiotics. The plasmid DNA profile analysis showed 3 types, and the relative molecular mass was approximately 4.7 ×10^6 , 3.6×10^6 and 2.0 ×10^6. The molecular biological characteristics showed these pathogens were ESBLs-producing K. pneumoniae, which was different from the control bacteria. At the same time, the pathogens caused the original infection were detected, and they were accordingly Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa. CONCLUSIONS The outbreak in burn patients is caused by ESBLs-producing K. pneumoniae, which has the same antibiotic resistance spectrum and plasmid DNA profile. This ESBLs-producing K. pneumoniae has the same origin. The pathogen might be transmitted by the case history clips and the door knobs. It was suggested that something must be done to enhance the antisepsis administration in order to prevent the hospital acquired infection.

关 键 词：烧伤患者 肺炎克雷伯菌 耐药谱 ESBLS检测 质粒DNA图谱 

分 类 号：R644[医药卫生—外科学]