脑外科医院获得性肺炎产超广谱β-内酰胺酶肺炎克雷伯菌的分子流行病学研究  

Molecular Epidemiology of Extended-spectrum β-lactamases producing Klebsiella pneumoniae isolated from neurosurgery patients with HAP

作　　者：穆雪鹍[1,2] 李亚珍 张向霞[1,2] 傅应云 

机构地区：[1]暨南大学第二临床医学院 [2]深圳市人民医院呼吸内科,518020

出　　处：《齐齐哈尔医学院学报》2012年第3期291-293,共3页Journal of Qiqihar Medical University

摘　　要：目的研究脑外科医院获得性肺炎(HAP)产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药性及ESBLs基因型。方法回顾性分析41例脑外科HAP产ESBLs肺炎克雷伯菌患者的临床资料,采用酶抑制剂增强法作ESBLs表型确证试验,纸片扩散法作药敏试验,聚合酶链反应(PCR)扩增ESBLs基因。结果产ESBLs肺炎克雷伯菌的阳性率为85.42%;仅对亚胺培南、美罗培南敏感;几乎所有病例均存在不规范使用抗生素、应用糖皮质激素、接受侵袭性操作等;SHV、CTX-M和TEM基因的检出率分别为73.17%(30/41)、63.26%(26/41)和14.63%(6/41);46.34%(19/41)的菌株同时携带多个基因。结论脑外科HAP产ESBLs肺炎克雷伯菌阳性率高、耐药情况严重,治疗应首选碳青霉烯类抗生素;不规范使用抗生素、应用糖皮质激素、接受各种侵袭性操作可能是其危险因素;最常见的ES-BLs基因型是SHV,其次为CTX-M。Objective To investigate the drug resistance and genotypes of extended-spectrum β-lactamases（ESBLs）-producing Klebsiella（K.） pneumoniae isolated from neurosurgery patients with hospital acquired pneumonia（HAP）.Methods Clinical isolates of ESBLs-producing K.pneumoniae isolated from lower respiratory tract samples of 41 patients with HAP studied retrospectively.Agar diffusion method was used to judge drug sensitivity.ESBLs were confirmed by inhibitor-potentiated test.ESBLs genotypes were analyzed by PCR.Results 85.42% of strains were considered ESBLs producers by phenotypic confirmatory test.These strains were only sensitive to imipenem and meropenem,and the sensitive rate was 100%.Almost all cases had the following conditions： unreasonably using antibiotics,especially oxyiminoβ-lactam antibiotics,using corticosteroids,applying invasive operations1.Of all ESBLs,73.17 %（30/41）were positive for SHV,63.26%（26/41）for CTX-M and 14.63%（6/41）for TEM.46.34%（19/41）of strains carried more than one type of ESBLs.Conclusions The prevalence of ESBLs was high in K.pneumoniae isolated from patients with HAP in the department of neurosurgery,and the resistant rates to most antibiotics were much higher.Carbopenems were the most effective antibiotics.Unreasonably using antibiotics,using corticosteroids,applying invasive operations might be the risk factors of ESBLs-producing K.pneumoniae.The most common ESBLs in K.pneumoniae were SHV,and the next was CTX-M in neurosurgery department.

关 键 词：医院获得性肺炎 超广谱 β-内酰胺酶 肺炎克雷伯菌 耐药 分子流行病学 

分 类 号：R978.11[医药卫生—药品]