婴幼儿下呼吸道肺炎克雷伯菌感染及其耐药性研究  

Investigation on Klebsiellapneumoniae caused infants lower respiratory tract infection and the antibiotic resistance

作　　者：李娜 杨蕊嘉[1] 叶倩[1] 党好[1] 刘晓岑[1] 张杰 裴晓方[1] 

机构地区：[1]四川大学华西公共卫生学院(华西第四医院),四川成都610041

出　　处：《现代预防医学》2012年第23期6126-6129,共4页Modern Preventive Medicine

基　　金：国家科技重大专项"传染病监测技术平台"项目"云南省周边省市传染病病原谱流行规律研究"课题(2009ZX10004-212)

摘　　要：目的了解婴幼儿下呼吸道感染肺炎克雷伯菌情况及耐药性,研究产超广谱β-内酰胺酶(ESBLs)菌株的基因型特征。方法采集患儿下呼吸道临床标本分离培养肺炎克雷伯菌;纸片扩散法(K-B法)检测菌株对常用抗生素的敏感度;耐药表型筛查产ESBLs菌株;PCR检测ESBLs基因(blaTEM,blaSHV,blaCTX-M和blaOXA)。结果 645例病例分离不重复肺炎克雷伯菌60株(9.3%);检出病例主要为新生儿及2岁以下婴儿(73.3%);临床表现主要为肺炎(73.0%)和支气管炎(20.6%)。药敏试验结果显示分离菌株对青霉素、头孢菌素及阿莫西林/克拉维酸耐药较严重。检出产ESBLs肺炎克雷伯菌29株(48.3%),表现出多重耐药但对碳青霉烯类及β-内酰胺酶抑制剂复合物较敏感。PCR扩增CTX-M、TEM和SHV基因的阳性率分别为89.7%、55.2%和34.5%,未检出OXA基因;69.0%的菌株同时携带两种及两种以上ESBLs基因型。结论婴幼儿下呼吸道肺炎克雷伯菌感染表现出年龄、性别差异;临床分离株对常用β-内酰胺类药物耐药性较高;产ESBLs菌株比例较高,以CTX-M型为主,多数菌株同时携带两种以上ESBLs基因型。OBJECTIVE To investigate infants lower respiratory tract infection（LRTI） for Klebsiellapneumoniae,and study the antibiotic resistance and genotype of ESBLs from clinical strains isolated.METHODS Sputum specimens for bacterial cultures were collected from infants with LRTI.Disk diffusion test（Kirby-Bauer test） was used for determination of anti-microbial susceptibility and screening of extended spectrum-β-lactamases（ESBLs） producing strains.Polymerase chain reaction（PCR） was performed for genes of ESBLs including blaTEM,blaSHV,blaCTX-M and bla0XA.RESULTS 60 strains of K.pneumoniae were isolated from 645 cases（9.3%） and most of infectious cases were infants under 1 year（58.3%）.The main symptoms were pneumonia（73.0%） and bronchitis（20.6%）.29 of 60 isolates were ESBLs producing K.pneumoniaewhich showed a multiple drug resistance.Three different types of ESBLs gene were observed except blaOXA,and the positive rate of blaCTXM,blaTEM and blaSHV was 89.7%,55.2% and 34.5% respectively.69.0% of these ESBLs producers carried multi-types of genes.CONCLUSION Infants＇ lower respiratory tract infection of K.pneumoniae shows characters of age and symptoms.β-lactamases antibiotic is highly resisted by isolated strains and the proportion of ESBLs-producing strains is high.CTX-M type ESBLs is prevalent and multi-type ESBLs genesare carried simultaneously.

关 键 词：肺炎克雷伯菌 耐药 ESBLS 基因型 婴幼儿 下呼吸道感染 

分 类 号：R378[医药卫生—病原生物学]