同产ESBLs及AmpC酶肺炎克雷伯菌的耐药性分析  

Drug resistance of both ESBLs and AmpC-producing klebsiella pneunomiae

作　　者：周庆[1] 吕火祥[2] 许玲英[1] 

机构地区：[1]浙江省海盐县人民医院检验科,浙江海盐县314300 [2]浙江省人民医院微生物室,浙江杭州310014

出　　处：《中华医院感染学杂志》2011年第1期11-13,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析儿童感染同产ESBLs和AmpC酶肺炎克雷伯菌的情况及其耐药性,以指导临床合理用药。方法对2009年1月-2010年1月医院就医儿童分离肺炎克雷伯菌122株,采用PCR法检测ESBLs酶基因blaTEM,blaSHV、blaCTX-M-9群,AmpC酶基因blaDHA、blaACT/MIR;K-B纸片琼脂扩散法检测肺炎克雷伯菌对抗菌药物的敏感性。结果 122株肺炎克雷伯菌中单纯AmpC酶基因阳性菌株7株,阳性率5.7%,单纯ESBLs基因阳性菌株37株,阳性率30.3%,ESBLs和AmpC酶基因同时阳性菌株检出率为9.0%,非产ESBLs和AmpC菌株67株,检出率55.0%;同产ESBLs和AmpC酶肺炎克雷伯菌除了对亚胺培南和美罗培南敏感外,对其余β-内酰胺类抗菌药物和头孢菌素类高度耐药,产酶菌株耐药率明显高于非产酶菌株。结论儿童感染肺炎克雷伯菌产ESBLs和AmpC酶的情况已经出现,产酶菌株对常用β-内酰胺类抗菌药物耐药率较高,其主要原因是肺炎克雷伯菌产ESBLs和AmpC酶;临床治疗应根据药敏指导合理使用抗菌药物。OBJECTIVE To investigate the prevalence and resistance of AmpC beta-lactamases and extended-spectrum betalactamases（ESBLs） produced by Klebsiella pneumoniae isolated from children.METHODS A total of 122 strains of K.pneumoniae were collected from the children from Jun 2009 to Jan 2010,using PCR method to detect ESBLs genes,blaTEM,blaSHV,blaCTX-M-9 groups and AmpC genes,DHA,ACT/MIR.K-B disk diffusion test was used to do the sensitivity test.RESULTS The positive rate of AmpC genes only,ESBLs genes only and both AmpC genes and ESBLs genes were 5.7%,30.33% and 9.0%,the detected rate of non-ESBLs and AmpC producing strains was 55.0%.All the isolated both ESBLs and AmpC β-lactamases producing strains were sensitive to imipenem and meropenem,but resistant to the rest of β-lactam antibiotics and the cephalosporin.The drug resistant rates of these isolates to other antibiotics were significantly higher than the isolates of non-ESBLs and AmpC β-lactamases producing.CONCLUSIONS Both ESBLs and AmpC β-lactamases producing K.pneumoniae has been occurred in this region and highly resistant rate to the β-lactam antibiotics,mainly due to ESBLs and AmpC β-lactamases produced by K.pneumoniae.Clinical treatment should be chosen according to the antimicrobial usceptibility test.

关 键 词：肺炎克雷伯菌 产超广谱Β-内酰胺酶 AMPC酶 耐药性 

分 类 号：R378[医药卫生—病原生物学]