苏州地区临床产超广谱 β-内酰胺酶肺炎克雷伯菌的耐药特征和耐药基因分型  

Resistant Phenotype and Genotype of Extended Spectrum β-lactamase Produced by Klebsiella Pneumoniae Isolated Clinically in Suzhou Area

作　　者：邱善敏[1] 杨仁洪[1] 唐旦丽[1] 钱雪峰[1] 

机构地区：[1]苏州大学附属第一医院检验科,江苏苏州215006

出　　处：《苏州大学学报（医学版）》2011年第6期977-980,共4页Suzhou University Journal of Medical Science

摘　　要：目的分析苏州地区临床产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药特征和耐药基因型分布情况。方法收集苏州地区5家医院2006年至2009年间自临床标本中分离的肺炎克雷伯菌512株,按CLSI规定的ESBLs初筛和确证试验检测ESBLs,以K-B琼脂扩散法进行药物敏感试验,用PCR方法对分离的产ESBLs菌株进行TEM、SHV和CTX-M基因型检测。结果产ESBLs肺炎克雷伯菌检出率为35.7%(183株),其中62.8%(115株)携带TEM型基因,36.1%(66株)携带SHV型基因,78.7%(144株)携带CTX-M基因。另外,有41.5%(76株)同时携带两种以上的基因。产酶株的耐药率均明显高于非产酶株(均P<0.05)。产酶株除对第4代头孢菌素和对加克拉维酸或他唑巴坦等第3代头孢菌素耐药率相对较低外,对其他抗生素均有相当高的耐药率。但无论是产酶株还是非产酶株对亚胺培南的耐药率均为0。结论苏州地区临床产ESBLs肺炎克雷伯菌已达到了较高的比例,并具有多重耐药的特点,其中CTX-M型是最主要的流行基因型。临床上严格控制和合理使用第3代头孢菌素已刻不容缓。Objective To study the resistant phenotype and the genotypical characteristics of extended spectrumβ-lactamases（ESBLs） in clinical isolates of Klebsiella pneumoniae.Methods Suzhou 5 hospitals isolated from clinical samples of Klebsiella pneumoniae 512,the provisions of ESBLs were detected from 2006 to 2009,and confirmed by CLSI phenotypic screening and confirmatory tests,the drug susceptibility was tested by the K-B agar diffusion method and TEM,SHV and CTX-M genotypes of ESBLs were determined by the specific PCR method.Results The detection rate of Klebsiella pneumoniae-pro-ducing ESBLs was 35.7%（183）,in which 62.8%（115 strain） carrying TEM-type gene,36.1%（66） carrying SHV-type gene,78.7%（144） carrying CTX-M genes.In addition,41.5%（76） also carried two or more genes.For ESBLs-producing strains except for having comparative low resistant rate for the 4th generation of cephalosporin and third generation of cephalosporin with clavulanic acid or tazobactam,resistance rate was,for all other antibiotics have high resistance rate,regardless of ESBLs producing or non producing strains resistance rate for imipenem was 0.Conclusions Klebsiella pneumoniae producing ESBLs in our region has reached a higher proportion and characteristics of multiple drug resistance,inclu- ding CTX-M-type is the main epidemic genotypes.Strictly controlling and rational clinical use of third-generation cephalosporins become essential.

关 键 词：肺炎克雷伯菌 超广谱Β-内酰胺酶 基因分型 

分 类 号：R378.996[医药卫生—病原生物学]