产超广谱β-内酰胺酶多重耐药的肺炎克雷伯菌相关基因研究  

The related gene research of multidrug resistance klebsiella pneumoniae producing extended spectrumβ-lactamaes

作　　者：李瑞蓉[1] 李连青[2] 李浩[3] 高亚静[4] 陕柏峰[4] 崔雪萍[2] 王春芳[4] 

机构地区：[1]山西中医学院第三中医院,太原市030006 [2]山西省临床检验中心,太原市030012 [3]山西医科大学第一医院,太原市030001 [4]山西医科大学,太原市030001

出　　处：《实用检验医师杂志》2014年第1期14-17,共4页Chinese Journal of Clinical Pathologist

基　　金：国家重大专项"艾滋病和病毒性肝炎等重大传染病防治"(2009ZX10004-203)

摘　　要：目的了解山西地区五家医院多重耐药的肺炎克雷伯菌(Klebsiella pneumoniae,KP)的耐药特点,并研究其产超广谱β-内酰胺酶(extended spectrumβ-lactamaes,ESBLs)多重耐药的KP相关基因的流行情况。方法收集2010年1月-2012年12月山西地区五家医院临床标本中分离的KP2516株,采用药敏试验(K-B法)和ESBLs确证实验筛选多重耐药的KP,采用PCR法扩增ESBLs多重耐药的KP相关基因,选取阳性产物进行测序并在Genbank进行分析。结果 2516株KP中,筛选出40株产ESBLs的多重耐药KP。PCR法基因扩增检测出40株blaTEM型,1株SHV型和4株KPC型;检测出染色体介导的GyrA型32株,质粒介导的qnrA型8株,qnrB型15株,以及qnrS型2株;没有检出金属酶NDM-1基因。结论多重耐药的KP耐药机制非常复杂,多重耐药菌株的出现导致同一菌株中同时携带几种基因。因此,应加强临床病例的监测,合理使用抗菌药物,减少泛耐药菌株的传播。Objective To investigate resistant characteristic ofmultidrug resistance Klebsiellapneumon/ae （KP） in the five hospitals of Shanxi province, and to study the related gene prevalence condition of multidrug resistance KP producing extended spectrum β-lactamaes （ESBLs） in several areas of Shanxi province. Methods 2516 strains of KP were isolated in clinical specimens from January 2010 to December 2012. multidrug resistance KP were detected by drug sensitive test（K-B method） and ESBLs confirmed experiment, The related gene of multidrug resistance KP was amplified by PCR method. The positive products were selected to sequenced, and the results were analyzed on Genbank. Results In 2516 strains of KP, 40 strains of multidrug resistence KP producing ESBLs were isolated. The detection of PCR method showed that there were 40 strains of TEM type, 1 strain of SHV type, 4 strains KPC type. There were 32 strains GyrA type chromosome-mediated, and 8 strains qnrA, 15 strains qnrB, 2 strains qnrS of plasmid-mediated. There was no metal enzyme NDM-1 gene detected. Conclusion The phenomenon of multidrug resistance KP is much more serious and the resistant mechanism is very complex as well. Multiple resistant strains lead to the same strains that carry several genes, so the monitoring of clinical cases should be strengthened and the use of antimicrobial agents should be rational so as to reduce the spread of resistant strains.

关 键 词：肺炎克雷伯菌 多重耐药 超广谱Β-内酰胺酶 基因型 

分 类 号：R446.5[医药卫生—诊断学]