小儿呼吸道感染肺炎克雷伯杆菌耐药性和基因型研究  

Drug resistance and genotype of Klebsiella pneumonia in children with respiratory tract infection

作　　者：包路 

机构地区：[1]临海市妇幼保健院,浙江临海317000

出　　处：《中国微生态学杂志》2012年第6期540-542,共3页Chinese Journal of Microecology

摘　　要：目的探讨临海地区小儿呼吸道感染肺炎克雷伯杆菌产超β-内酰胺酶(ESBLs和AmpC酶)的耐药性及耐药基因型分布情况。方法采用VITEK-60型全自动细菌鉴定仪鉴定细菌,按CLSI推荐的确证试验检测ESBLs和K-B纸片法测定药敏结果;采用头孢西丁纸片扩散法筛选产AmpC酶阳性菌株,采用PCR检测AmpC酶基因,并对产物进行测序分析基因型。结果 113株肺炎克雷伯杆菌ESBLs和AmpC酶总检测率分别为29.20%和18.58%,其中单产ESBLs、单产AmpC酶和同产AmpC酶+ESBLs检出率分别为23.01%、12.39%和6.19%;AmpC酶阳性菌株的耐药基因型:16株为DHA-1型,5株为ACT-1型。药敏试验:所分离的肺炎克雷伯杆菌对亚胺培南全部敏感,对喹诺酮类耐药率很低,对大多β-内酰胺类抗生素耐药率较高,并且产酶株的耐药性明显高于非产酶株,耐药现象在同产ES-BLs和AmpC酶菌株中更为严重。结论临海地区小儿呼吸道分离的肺炎克雷伯杆菌产ESBLs和AmpC酶检出率较高;AmpC酶以DHA-1基因型流行为主,产酶株呈现出高度多重耐药性。Objective To investigate the resistance and resistant genotype distribution of KlebsieUa pneumoniae produ- cing uhra-β-lactamases （ESBLs and AmpC enzymes） in children with respiratory tract infections in Linhai. Method VITEK- 60 Automatic bacterial identification instrument was used to identify the ESBLs bacteria according to the CLSI-recommended confirmatory test detected, and K-B disk method was used to determine the susceptibility; Cefoxitin disk diffusion method was used to screen AmpC-producing strains, and PCR was used to detect AmpC enzyme gene ; the products were sequenced for gen- otypes. Result Of the 113 strains of Klebsiella pneumonia, the total detection rates of ESBLs and AmpC were 29.20% and 18.58% respectively, in which the rates of ESBLs, AmpC enzymes and AmpC enzyme ＋ ESBLs were 23.01% , 12.39% and 6.19%, respectively. The resistant genotypes of AmpC-positive strains were DHA-1 （16 strains） and ACT-1 （5 strains）. All the Klebsiella pneumoniae isolated were sensitive to imipenem ; The resistance was very low to quinolones, while higher to most β-lactam antibiotics, and the enzyme-producing strains were significantly more resistant than non-enzyme producing strains. The drug resistance of the strains producing both ESBLs and AmpC was the highest. Conclusion The detection rate of ESBLs and/or AmpC enzyme producing Klebsiella pneumonia isolated from pediatric respiratory, tracts was high in Linhai region. DHA-1 was the main genotype among AmpC enzyme, and the enzyme producing strains showed a high degree of multi-drug reslstance.

关 键 词：肺炎克雷伯杆菌 小儿呼吸道感染 ESBLS AMPC酶 耐药性 基因型 

分 类 号：R378.996[医药卫生—病原生物学]