烧伤患者肺炎克雷伯菌的耐药表型及同源性分析  

Analysis of resistance phenotype and homology of Klebsiella pneumoniae in burn patients

作　　者：刘小玲[1] 彭代智[1] 薛亮[2] 舒文婷[1] 周新[1] 刘敬[1] 

机构地区：[1]第三军医大学西南医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆400038 [2]中山大学附属第一医院烧伤科

出　　处：《中华烧伤杂志》2012年第2期96-100,共5页Chinese Journal of Burns

基　　金：基金项目：国家科技支撑计划（2009BA187B03）

摘　　要：目的 了解烧伤感染患者肺炎克雷伯菌（ KPN）的耐药表型及同源性。 方法 收集2007年1月-2011年6月由西南医院全军烧伤研究所（简称本研究所）住院患者创面、血液、痰液、静脉导管、大便、口腔等分离的KPN共54株，经鉴定后采用K-B纸片扩散法检测菌株对氨苄西林、替卡西林等18种临床常用抗生素的耐药性。根据菌株耐药性筛选m产超广谱B内酰胺酶（ESBL）的KPN，PCR法检测其耐药基因SHV、TEM、CTX-M阳性率，采用脉冲场凝胶电泳及聚类分析法分析菌株同源性，另对各年检出的产ESBL的KPN进行同源性分析。 结果 （1）54株KPN对亚胺培南、美罗培南和厄他培南的敏感率依次为96. 30%、92. 59%、81. 48%，对头孢替坦、头孢西丁的敏感率为70. 37%和64. 81%，对头孢他啶的敏感率为57. 41%，对其他抗生素的敏感率均低于40.00%。（2）共筛选出26株产ESBL的KPN，其SHV、TEM、CTX-M阳性率分别为96. 150/0（ 25/26）、76. 92%（ 20/26）、57. 69% （15/26）。同时携带前述3种基因的菌株检出率为42. 31%（ 11/26），SHV和TEM取阳性菌株检出率为34. 62%（ 9/26），仅携带单一基因的菌株检出率均小于10.00%。（3）产ESBL的KPN共分为9种基因型，A、B、C、D、E型分别占30. 77%（ 8/26）、19.23% （5/26）、15. 38%（ 4/26）、11.54%（ 3/26）和7.69%（ 2/26），F、G、H和I型均分别占3.85%（ 1/26）。（4）2007、2010年产ESBL的KPN基因型均以A型为主，分别占2/3和1/2；2008年C、E、F型各1株；2009年以B型为主，占1/2；2011年A、D、H、I型各1株。 结论 本研究所烧伤感染患者KPN对临床常用抗生素耐药性高，可选择碳青霉烯类药物治疗。产ESBL的KPN大部分同时携带2种或者3种耐药基因，基因型以A型为主。Objective To study the resistance phenotype and homology of Klebsiella lmeumoniae （ KPN ） in burn patients with infection. Methods Fifty-four strains of KPN were isolated from wound excretion, blood, sputum, venous catheter, feces, and oral eavit） of patients hospitalized in Institule of Burn Research of Southwest Hospital （briefly called our inslilute） from January 2007 to June 2011, Drug resist- anee of the 54 strains of KPN to 18 antibiotics commonly used in clinic, including ampicillin, tiearcillin, etc. was tesled by K-B paper disk diffusion method after being identified. Extended-spectrum β-laetamase （ESBL）-producing KPN was screened based on the drug resistance result. The positive rates of drug-resist- ant genes SHV, TEM, and CTX-M of lhe ESFll,-produeing KPN were deteete（：l t.y polymerase ehain reaction. The homology of lhe ESBl,-produeing KPN was analyzed by pulse fiehl gel eleetrophoresis and clustering methodology. The homolog of ESBL-produeing KI：＇N isolated in each year was analyzed ton. Results （1） The sensitive rate of the54 strains of KPN to imipenem, meropenem, and ertapenem was respectively 96.30% , 92.59% , and 81.48% , that of these strains to cefftetan and eefoxifin was respectively 70.37% and 64.81 % , and lhat of these strains to cefiazidime was 57.41 %. The sensitive rates of the 54 strains of KPN to the otherantibioties were all lower than40.00%. （2） Twenty-six ESB1,-producing KPN strains were screened and the positive rate of SI-IV, TEM, and CTX-M was 96.15% （25/26）, 76.92% （20/26）, and 57.69% （15/26）, respectively. Detection rate of ESBL-producing KPN strains carrying three genes at the same time was 42.31% （11/26）, that of these strains carrying both SHV and TEM was 34.62% （9/26）, and those of these strains carrying only a single gene were all less than 10.00%. （3） The twenty-six ESBL- producing KPN were classified into 9 gene types, with 30.77% （8/26） in type A, 19.23% （5/26） in type B, 15.38% （4/26） in type C, 11.54

关 键 词：烧伤 感染 克霄伯茼 肺炎 Β内酰胺酶类 耐药基因 

分 类 号：R446.5[医药卫生—诊断学]