全国10所教学医院产ESBLs和质粒AmpC酶大肠埃希菌及肺炎克雷伯菌的研究  被引量:31

Genotype distribution of extended-spectrum and AmpC β-lactamases produced by Escherichia coli and Klebsiella pneumoniae in 10 teaching hospitals of China

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作  者:孙宏莉[1] 宁永忠[2] 廖康[3] 王辉[1] 朱任媛[1] 

机构地区:[1]中国医学科学院中国协和医科大学北京协和医院检验科,北京100730 [2]北京大学附属第三医院检验科 [3]广州中山大学附属第一医院检验科

出  处:《中国感染与化疗杂志》2007年第5期323-329,共7页Chinese Journal of Infection and Chemotherapy

摘  要:目的研究全国10所教学医院临床分离的大肠埃希菌和肺炎克雷伯菌中同时产ESBLs及质粒型AmpC酶菌株的比率及其基因型特点,比较不同地区间的差别。方法收集来自中国不同地区的10所教学医院2003年度产ESBLs的大肠埃希菌90株和肺炎克雷伯菌61株,用等电聚焦电泳测定β内酰胺酶的等电点;接合试验证实酶基因有无可转移性;采用多重聚合酶链反应(MPCR)及序列分析确定质粒AmpC酶的基因型。结果武汉、南京、济南等地产ESBLs大肠埃希菌及肺炎克雷伯菌所占比率相近,均在50%左右;北京产ESBLs大肠埃希菌所占比率低于肺炎克雷伯菌;其他各城市产ESBLs大肠埃希菌所占比率均略高于肺炎克雷伯菌。在产ESBLs菌株中24.4%大肠埃希菌和19.4%肺炎克雷伯菌对头孢西丁耐药。除沈阳无对头孢西丁耐药菌株外,其他医院均存在对头孢西丁耐药株。产ESBLs菌株基因型主要为CTX—M型,其中以CTX-M-9组最为常见,其次为CTX-M-1组。在同时产ESBLs和AmpC的菌株中,肺炎克雷伯菌多于大肠埃希菌,且均为CTX-M/ DHA-1型(多为CTX-M-9/DHA-1型)。3株同时产ESBLs和AmpC肺炎克雷伯菌的接合子PCR结果与其供体菌完全相同。结论参与本研究的各所教学医院产ESBLs菌株基因型主要为CTX-M-9组,在同时产ESBLs和AmpC酶的菌株中,肺炎克雷伯菌多于大肠埃希菌,多为CTX-M-9/DHA-1型,该酶可通过质粒传播。Objective To investigate the genotype distribution of extended-spectrum β-lactamases (ESBLs) and AmpC β-1actamases produced by Escherichia coli and Klebsiella pneumoniae in 10 teaching hospitals of China. Methods 90 clinical strains of E, coli and 61 strains of K. pneumoniae isolated in 2003 and confirmed to produce ESBLs were collected from 10 teaching hospitals in China. Analytical isoelectric focusing was used to measure the pI of the β-1actamases. Conjugation experiment was used to study the transfer of cefoxitin resistance. Plasmid-mediated AmpC enzyme genes were amplified and sequenced by multiplex polymerase chain reaction (MPCR). Results The prevalence of ESBL-producing E. coll and K. pneumoniae was about 50% in Wuhan, Nanjing and Jinan. The prevalence of ESBL-producing E. coli was lower than K. pneumonlae in Beijing. However, in other hospitals the prevalence of ESBL-producing E. coli was a little higher than K. pneumoniae. About 24. 4% of ESBL-producing E, coli isolates and 19.4% of ESBL-producing K. pneumoniae isolates were resistant to cefoxitin. Cefoxitin-resistant isolate was identified in all hospitals except Shenyang. Major genotype of ESBL-producing isolates was CTX-M. The CTX-M-9 group was the most common group, followed by CTX-M-1. More K. pneumoniae isolates produced both ESBLs and AmpC en- zyme than E. coll. The genotype was CTX-M/DHA-1. The PCR results of 3 transconjugants producing both ESBLs and AmpC enzyme were the same as their donor isolates. Conclusions The genotype of ESBL-producing isolates is mainly CTX-M-9 group in these teaching hospitals. More K. pneumoniae isolates produced both ESBLs and AmpC enzyme than E. coli. Most of these isolates are due to genotype CTX-M/DHA-1, which can spread through plasmid.

关 键 词:超广谱Β内酰胺酶 质粒型AMPC酶 CTX-M-9组酶 DHA-1型酶 

分 类 号:R450[医药卫生—治疗学]

 

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