血流感染中大肠埃希菌及肺炎克雷伯菌耐药特征及基因分型  

Drug resistance characteristics and genotypes of Escherichia coli and Klebsiella pneumoniae in bloodstream infections

作　　者：郭亮 张传领[2] 王白永[1] GUO Liang;ZHANG Chuan-ling;WANG Bai -yong(Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang 310015,China)

机构地区：[1]杭州师范大学附属医院,浙江杭州310015 [2]浙江萧山医院,浙江杭州311201

出　　处：《中国卫生检验杂志》2018年第23期2855-2858,共4页Chinese Journal of Health Laboratory Technology

基　　金：浙江省医学会临床科研资金项目(2015ZYC-A39)

摘　　要：目的通过检测血流感染中大肠埃希菌和肺炎克雷伯菌耐药特征及基因型特征,探讨产ESBLs菌株的流行病学情况,为临床抗感染治疗提供依据。方法收集浙江萧山医院2015年6月-2017年6月血流感染中大肠埃希菌和肺炎克雷伯菌,进行细菌鉴定和药物敏感试验,对ESBLs阳性菌株进行PCR扩増,明确基因分型。结果共分离到大肠埃希菌62株,肺炎克雷伯菌46株,产ESBLs检出率分别为48. 4%和32. 6%。产ESBLs大肠埃希菌和肺炎克雷伯菌对氨苄西林、庆大霉素、复方新诺明、头孢他啶、头孢噻肟、头孢吡肟耐药率较高(>50%),对磷霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及阿米卡星耐药率较低(<20%)。基因筛查结果显示,血流感染流行的ESBLs基因型主要为CTX-M型,排在前3位的基因型为CTX-M-14、CTX-M-15和CTX-M-55。结论血流感染中大肠埃希菌和肺炎克雷伯菌产ESBL比率较高,流行的基因型以CTX-M型为主。Objective By investigating the clinical epidemiology and genotypes of Escherichia coli and Klebsiella pneumoniae in bloodstream infections and exploring the clinical epidemiology of ESBLs-producing strains,to provide basis for clinical anti-infective therapy. Methods The strains of Escherichia coli and Klebsiella pneumoniae were collected in Zhejiang Xiaoshan Hospital from June 2015 to June 2017. The bacterial identification and drug sensitivity test were carried out. The ESBLs positive strains were amplified by PCR,and the genotyping was confirmed. Results A total of 62 strains of Escherichia coli and 46 strains of Klebsiella pneumoniae were collected. The detection rate of Escherichia coli producing ESBLs was 48. 4%,and that of K. pneumoniae producing ESBLs was 32. 6%. Escherichia coli and Klebsiella pneumoniae producing ESBLs were the high resistant to ampicillin,gentamicin,cotrimoxazole,ceftazidime,cefotaxime,cefepime( > 50%),low resistant to fosfomycin,piperacillin/tazobactam,cefoperazone/sulbactam and amikacin( < 20%). The genotype of ESBLs was mainly CTX-M,and the top three genotypes were CTX-M-14,CTX-M-15 and CTX-M-55. Conclusion Escherichia coli and Klebsiella pneumoniae in bloodstream infections had a higher rate of ESBL. The prevailing genotype was CTX-M.

关 键 词：大肠埃希菌 肺炎克雷伯菌 耐药性 血流感染 基因型 

分 类 号：R446.5[医药卫生—诊断学]