儿童呼吸道感染产超广谱β-内酰胺酶细菌的耐药表型及耐药基因研究  

Preliminary study on resistant phenotype and genotype of extended spectrum β-lactamases producing bacteria in children with respiratory tract infection

作　　者：林海波[1,2] 张国成[1] 许东亮[1] 徐修礼[3] 樊蕊[1] 邓军霞[1] 刘雪[1] 刘瑞清[1] 杨佩红[3] 

机构地区：[1]第四军医大学西京医院儿科,陕西西安710032 [2]西安市第四医院儿科,陕西西安710004 [3]第四军医大学西京医院检验中心细菌室,陕西西安710032

出　　处：《临床儿科杂志》2013年第2期129-133,共5页Journal of Clinical Pediatrics

摘　　要：目的了解儿童呼吸道感染产超广谱β-内酰胺酶（ESBLs）细菌的耐药表型及其基因分型特征。方法收集2011年10月至2012年7月临床分离的呼吸道感染ESBLs细菌，用K-B纸片扩散法检测其对11种抗生素的耐药状况，并采用PCR技术分析其耐药基因。结果检出儿童呼吸道感染产ESBLs细菌47株，主要为大肠埃希菌和肺炎克雷伯菌（产酶率分别为52．0％、47．7％）。产ESBLs细菌对头孢类抗生素高度耐药（头孢他啶、头孢呋辛、头孢曲松耐药gN100．0％），对头孢吡肟部分耐药（耐药率26．9％～38．1％），对β-内酰胺类抗生素／酶抑制剂复合物耐药率有差异（依次为氨苄西林／舒巴坦、头孢哌酮，舒巴坦、哌拉西林他唑巴坦），对亚胺培南及美洛培南耐药率为0。耐药基因型有TEM,SHVCTX-M-1组、CTX-M-9组基因，以CTX-M-9组最多见。结论产ESBLs细菌具有多重耐药的表型特征，对头孢类抗生素高度耐药，对酶抑制剂复合物部分敏感，对碳青霉烯类抗生素完全敏感。以质粒介导的多种耐药基因表达赋予了产ESBLs细菌多种耐药表型。Objective To investigate the resistant phenotype and genotype of extended spectrum β-1actamases （ESBLs） producing bacteria in children with respiratory tract infection. Methods ESBLs producing bacteria isolated from children with respiratory tract infection were collected from October 2011 to July 2012. Susceptibility testings against 11 antibiotics were performed by K-B slip of paper diffusion process, and the primary drug resistant genotypes of ESBLs producing bacteria were detected by PCR method. Results Forty-seven strains of ESBLs producing bacterium were isolated with Escherichia coli and Klebsiella pneumoniae as the main bacteria （the rates of enzyme production were 52.0% and 47.7% respectively）. ESBLs producing bacteria were highly resistant to cephalosporin （the resistant rates to ceftazidime, cefuroxime, ceftriaxone were 100.0%）, and partially resistant to cefepime （the resistant rate was between 26.9% and 38.1%）. The resistant rates of β-lactamases antibiotics/inhibitors were observed significantly different among ampicillin/salbactam, cefoperazone/sulbactam, and piper- acillin/tazobactam. The resistance rates to imipenem and meropenem were 0%. The genotypes of drug resistance included TEM, SHV, CTX-M-1 group and CTX-M-9 group. The CTX-M-9 group was the primary genotype. Conclusions ES13Ls producing bacteria show multiple-drug resistance with high resistance to cephalosporin, partial susceptibility to β-1actamases antibiotics/inhibitors and full susceptibility to carbapenems. The expression ofplasmid-mediated multiple drug resistance genegiven the multiple drug resistance phenotype of ESBLs producing bacteria.

关 键 词：呼吸道感染 超广谱Β-内酰胺酶 耐药 基因 儿童 

分 类 号：R446.5[医药卫生—诊断学]