产多种β-内酰胺酶肺炎克雷伯菌的基因型研究  

Genotypes of β-lactamases produced by Klebsiella pneumoniae

作　　者：郭远瑜[1] 魏泽庆[1] 朱佩琼[2] 杜小幸[1] 杨青[1] 沈萍[1] 俞云松[1] 

机构地区：[1]浙江大学医学院附属第一医院,传染病诊治国家重点实验室,杭州310003 [2]浙江医学高等专科学校内科教研室

出　　处：《中华临床感染病杂志》2010年第3期138-141,共4页Chinese Journal of Clinical Infectious Diseases

基　　金：浙江省教育厅科研项目（20071344）;浙江省医药卫生科学研究基金（200708479）

摘　　要：目的 研究医院感染肺炎克雷伯菌的β-内酰胺酶基因型.方法 连续收集从临床住院患者中分离的肺炎克雷伯菌,采用接合试验、PCR、PCR产物测序、等电聚焦试验、超广谱β-内酰胺酶（ESBLs）确认试验等方法明确基因型.结果 共收集75株肺炎克雷伯菌,48株（64.0%,48/75）含β-内酰胺酶基因,其中ESBLs占52.0%（39/75）.在48株产酶菌株中,携带2种基因型的占35.4%（17/48）,携带3种基因型的占14.6%（7/48）,携带4种基因型的占10.4%（5/48）.CTX-M型β-内酰胺酶基因的检出率最高（30/48,62.5%）,其次为TEM型（26/48,54.2%）和SHV型（25/48,52.1%）.产DHA-1型AmpC酶的肺炎克雷伯菌有9株,且有8株与ESBLs并存.同时还检测到3株产KPC-2型碳青霉烯酶肺炎克雷伯菌.ESBLs表型确认试验结果的假阴性率为23.1%（9/39）.结论 医院感染肺炎克雷伯菌的β-内酰胺基因分布复杂,临床上呈多药耐药状态.Objective To investigate the genotypes of β-lactamases produced by Klebsiella pneumoniae.Methods Plasmid conjugation,PCR amplification,gene cloning and DNA sequencing,isoelectric focusing electrophoresis and extended-spectrum β-lactamase（ESBLs）confirmatory test were carried out for analyzing the encoding gene of β-lactamases in clinical strains of Klebsiella pneumoniae collected from hospital wards.Results Totally 75 clinical strains of Klebsiella pneumoniae were collected,in which 48 strains were confirmed to produce genotype of β-laetamases（64.0%）,including 39 ESBLs-producing Btraim（52.0%）.Among 48 strains,17 isolates（35.4%）carried 2 types of ESBLs genes,7（14.6%）carried 3 types of ESBL8 genes,and 5（10.4%）carried 4 types of ESBLs genes.CTX-M was the most comon type（30/48,62.5%）,followed by TEM（26/48,54.2%）and SHV（25/48,52.1%）.Among 9 isolates with DHA-1 AmpC β-laetamase,8 produced AmpC β-lactamases and ESBLs.Class A carbapenemase KPC-2 was produced in 3 isolates.False negative rate of ESBLs confirmatory test was 23.1%（9/39）.Condusion Genotypes of β-lactamases produced by Klebsiella pneumoniae are complicated,which results in multi-drug resistance in clinic.

关 键 词：Β-内酰胺酶类 基因型 克雷伯菌 肺炎 聚合酶链反应 

分 类 号：R446.5[医药卫生—诊断学]