广州地区具有水解头孢他啶活性的CTX-M型ESBLs的调查  

Research of CTX-M-type ESBLs to hydrolyze ceftazidime in Guangzhou

作　　者：黎晓强[1] 卓超[1,2] 苏丹虹[2] 李红玉[3] 王露霞[4] 廖康[5] 王媚[6] 植志全 郭仲辉[8] 魏衍超[9] 耿穗娜[10] 金光耀[2] 钟南山[2] 

机构地区：[1]重庆医科大学第一附属医院 [2]广州医学院,呼吸疾病国家重点实验室 [3]中山大学附属第二医院 [4]广州军区广州总医院 [5]中山大学附属第一医院 [6]广东省人民医院 [7]广州花都区人民医院 [8]广州番禺区人民医院 [9]广州医学院第二附属医院 [10]南方医科大学南方医院

出　　处：《中国抗生素杂志》2010年第5期383-387,共5页Chinese Journal of Antibiotics

基　　金：国家传染病重大专项"新发和突发传染病病原快速诊断和高通量检测技术平台建设"(2009ZX10009-104)

摘　　要：目的对广州地区具有水解头孢他啶活性的CTX-M型ESBLs进行调查,了解其种类、比例以及传播机制,为临床抗生素的使用提供指导。方法对广州地区多家医院2007年到2008年临床分离的非重复的确证产ESBLs的181株大肠埃希菌和180株肺炎克雷伯菌进行研究,PCR方法确定CTX-M型ESBLs的基因型,MIC检测菌株对抗菌药物的敏感性;接合实验了解CTX-M型的ESBLs编码基因(blaCTX-M)所在质粒的大小。结果检出携带blaCTX-M-15的菌株共86株(23.8%),其中大肠埃希菌和肺炎克雷伯菌分别为39株(21.5%)和47株(26.1%);大肠埃希菌和肺炎克雷伯菌中各检出1株携带blaCTX-M-27的菌株,比率均为0.55%,未发现携带blaCTX-M-16的菌株。接合实验发现,大肠埃希菌和肺炎克雷伯菌中携带blaCTX-M-15的质粒分别是65Kb和92Kb大小的可接合性质粒;肺炎克雷伯菌中携带blaCTX-M-27的质粒推测是大小为57Kb的可结合性质粒。结论广州地区具有水解头孢他啶活性的CTX-M型ESBLs的类型为CTX-M-15和CTX-M-27,且以CTX-M-15为主。耐药基因所在的质粒为可接合性质粒,能通过接合水平传播。鉴于CTX-M-15型ESBLs在临床菌株中检出率较高,治疗上应避免单独使用头孢他啶。Objective To research the genotype, proportion and disseminative mechanism of CTX-M-type ESBLs hydrolyzing ceftazidime in Guangzhou. Methods 181 non-duplicate clinical isolates of E.coli and 180 nonduplicate clinical isolates of K.pneumoniae were studied, which collected from 9 hospitals in Guangzhou, from 2007 to 2008. PCR method was used to detect the genotypes, MIC was used to determine the sensitivity of antibiotics, and the size ofplasmid containing blaCTX-M-15 was investigated by conjμgation test. Results 86（23.8%） isolates belong to the blaCTX-M-15 in which E. coli and K. pneumoniae were 39 （21.5%） isolates and 47 （26.1%） isolates respectively. One isolate containing blaCTX-M-27 was detected in E.coli and K. pneumoniae respectively, with the same rate of 0.55%. The blaCTX-M-16 was not detected in this study. Conjμgation revealed the sizes ofplasmids containing blaCTX-M-15 are 65Kb and 92Kb in E.coli and K. pneumoniae, respectively. The blaCTX-M-27 in K.pneumoniae maybe exist in the plasmid which size is 57Kb. Conclusion The genotypes of CTX-M hydrolyzing ceftazidime in guangzhou are blaCTX-M-15 and blaCTX-M-27 meanwhile the blaCTX-M-15 is predominate. The blaCTX-M-15 exists in the conjμgative plasmid and is detected in clinic isolates frequently. As a result, it is better to avoid to use ceftazidime alone in clinic therapy.

关 键 词：头孢他啶 CTX-M-15 CTX-M-27 接合性质粒 

分 类 号：R978.11[医药卫生—药品]