医院感染肺炎克雷伯菌耐药趋势及β-内酰胺酶基因型分析  

Trend of drug resistance and β-lactamase genes in Klebsiella pneumoniae causing nosocomial infection

作　　者：张虎[1] 闫中强[2] 曹晋桂[1] 杨得明 吴镝[1] 刘芳[1] 马文杰[1] 刘运喜 

机构地区：[1]空军总医院感染管理科,北京100142 [2]解放军总医院南楼临床部感染管理科 [3]感染管理与疾病控制科,北京100853

出　　处：《中华医院感染学杂志》2014年第21期5207-5209,5232,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30872155)

摘　　要：目的了解医院重症监护病房2009-2013年医院感染肺炎克雷伯菌的耐药趋势以及10种β-内酰胺酶耐药基因的分布,为临床正确选择抗菌药物提供依据。方法 K-B法检测165株肺炎克雷伯菌对20种抗菌药物的耐药性,PCR方法检测:CTX-M、TEM、SHV、GES、KPC、IMI、IMP、VIM、NDM、GIM耐药基因。结果 ICU 5年共分离165株肺炎克雷伯菌,产ESBLs菌株88株,KPN对三代头孢菌素的耐药率逐年升高;自2011年出现碳青霉烯耐药的菌株,耐药率约10.0%;114株扩增到耐药基因片段,检测出CTX-M、TEM、SHV、KPC共4种耐药基因,165个基因片段;最主要的耐药基因型为SHV型,占46.5%。结论产ESBLs菌株的增加和耐碳青霉烯肺炎克雷伯菌的出现,应引起高度重视,关注细菌的变迁和耐药性变化,并合理选用抗菌药物治疗。OBJECTIVE To understand the trend of drug resistance and the distribution of 10 kinds of β-lactamase drug resistance genes in the K lebsiella pneumoniae causing nosocomial infection in intensive care unit from 2009 to 2013 so as to provide guidance for reasonable clinical use of antibiotics .METHODS The drug resistance of 165 strains of K . pneumoniae to 20 antibiotics was determined by using K-B method ,and the PCR method was employedtodetectthedrugresistancegenes,includingCTX-M,TEM,SHV,GES,KPC,IMI,IMP,VIM, NDM ,and GIM .RESULTS A total of 165 strains of K .pneumoniae have been isolated from ICUs in the 5 years , including 88 ESBLs-producing strains . The drug resistance rate of the K . pneumoniae strains to the third generation cephalosporins was increased year by year .The carbapenem-resistant strains have emerged since 2011 , and the drug resistance rate was about 10 .0% .The drug resistance gene fragments were amplified for 114 strains , and 4 kinds of drug resistance genes were detected ,including CTX-M , TEM , SHV ,and KPC ,165 gene fragments in total; the SHV was the predominant drug resistance genotype , accounting for 46 .5% . CONCLUSIONS It is necessary to pay great attention to the increase of the ESBLs-producing strains and the emergence of carbapenem-resistant K .pneumoniae ,focus on the variation of the bacterial species and the change of drug resistance ,and reasonably use antibiotics .

关 键 词：肺炎克雷伯菌 耐药基因 Β-内酰胺酶 

分 类 号：R378.996[医药卫生—病原生物学]