大肠埃希菌及肺炎克雷伯菌耐药基因分析  

Analysis of antimicrobial resistance genes of Escherichia coli and Klebsiella pneumoniae

作　　者：王震[1] 周丽萍[1] 庄建伟[1] 刘智成[1] 汪海青 

机构地区：[1]江苏省镇江市第二人民医院检验科,212002

出　　处：《中国公共卫生》2008年第7期818-820,共3页Chinese Journal of Public Health

基　　金：镇江市社会发展基金资助项目(SH2005032)

摘　　要：目的了解现阶段产超广谱β-内酰胺酶(ESBLs)和头孢菌素酶(AmpC酶)的大肠埃希菌和肺炎克雷伯菌的耐药特性及基因型分布,并作同源性分析。方法纸片扩散法(K-B)检测细菌对抗生素的敏感性;双纸片扩散确诊试验检测ESBLs;三维试验检测AmpC酶;聚合酶链反应(PCR)检测基因型;肠杆菌科基因间重复一致序列(ERIC)PCR作分子生物学分型。结果产酶菌株对亚胺培南、美罗培南、阿米卡星、头孢吡肟耐药性较低,对其他13种抗生素耐药性较高。在PCR扩增试验中,blaCTX-M、blaTEM、blaOXA、blaSHV、blaVEB-1型ESBLs基因及CIT、DHA型AmpC酶基因阳性率分别为75.2%,35.8%,11.0%,4.6%,0.9%,4.6%和4.6%;有46.8%的菌株同时携带多种耐药基因。用ERIC-PCR法将所检测的大肠埃希菌和肺炎克雷伯菌分成42型和22型。结论产ESBLs和AmpC酶大肠埃希菌和肺炎克雷伯菌的耐多药性值得关注;ESBLs及AmpC酶分别以CTX-M型及CIT型和DHA型为主;产酶菌株有散在的克隆流行,应注意监控,防止耐药菌株引起院内感染。Objective To understand the current resistance and genotype of extended - spectrum beta - lactamase（ES- BLs）and AmpC- producing Escherichia coli and Klebsiella pneumoniae and to perform homology analysis. Methods Antibiotic susceptibility test was performed by Kirby - Bauer method. ESBLs - producing isolates were confirmed by double disk diffusion confirming test. AmpC β - lactamases were detected by the three - dimensional test. PCR was performed to understand the genotype of ESBLs and AmpC β - lactamases. DNA fingerprints of isolates were constructed by enterobacterial repetitive intergenic consensus PCR（ ERIC- PCR）. Results Enzyme- producing strains were more sensitive to Imipenem, Meropenem, Amikacin and Cefepime but resistant to 13 other antimicrobials. 75.2 %, 35.8 %, 11.0 %, 4.6 %, 0.9 %, 4.6 % and 4.6 % of the isolates was found carried blaCTX - M, blaTEM, blaOXA, blaSHV, blaVEB - 1, CIT and DHA gene, respectively, by PCR. In addition, 46.8 % of all strains carried more than one β - lactamase gene. The genotype of E. coli and K. pneu was divided into 42 and 22 clusters by ERIC- PCR. Conclusion Attention should be paid to multidrug resistance of enzyme- producing E. coli and K. pneu. BlaCTX- M and CIT, DHA were the predominant genotypes in ESBLs - producing and AmpC - producing strains. The prevalence of multidrug resistance clone in the clinic reminded us to control nosocomial infection effectively.

关 键 词：超广谱Β-内酰胺酶 头孢菌素酶 耐药性 基因型 同源性 

分 类 号：R378.2[医药卫生—病原生物学]