超广谱β-内酰胺酶肺炎克雷伯菌底物筛选与耐药性及耐药基因分型研究  

A study of a substrate to screen for extended-spectrumβ-lactamase-producing Klebsiella pneumoniae,the drug resistance of K.pneumoniae,and genotyping of its drug resistance genes

作　　者：张晶晶[1] 谢永富[1] 黄印启[1] 王鹏[1] 

机构地区：[1]河北医科大学第三医院检验科,河北石家庄050051

出　　处：《中国病原生物学杂志》2016年第7期661-664,668,共5页Journal of Pathogen Biology

摘　　要：目的探讨产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌（Klebsiella pneumoniae,Kp）的最佳筛选底物、发生率、耐药性及耐药基因分型,为合理用药及制定预防方案提供参考。方法收集2015年1月～2016年1月本院分离的98株肺炎克雷伯菌进行ESBLs筛选及确证,计算其发生率,比较确证结果及底物初筛结果,确定ESBLs菌株最佳筛选底物,并进行16种抗生素的药敏试验,观察产ESBLs肺炎克雷伯菌耐药性。分析产ESBLsKp质粒谱,对其携带的ESBLs耐药基因进行PCR扩增与分型。结果产ESBLs肺炎克雷伯菌分离率为25.51%,头孢噻肟是其最佳底物,灵敏度高达100%;其次为头孢曲松、氨曲南、头孢泊肟;头孢他啶作为底物时的灵敏度最低,为60.42%,且漏检率较高。产ESBLs菌对亚胺培南耐药率为0,对丁胺卡那、头孢哌酮/舒巴坦及头孢西丁的耐药率分别为20.00%、33.00%和23.00%,对其他12种抗生素均有较高耐药性。产ESBLs肺炎克雷伯菌携带的β-内酰胺酶基因型主要包括：TEM型、SHV型、非TEM及非SHV型。结论肺炎克雷伯菌对头霉素类、亚胺培南及含有β-内酰胺酶抑制复合物等药物敏感,这几类抗生素可用于治疗产ESBLs肺炎克雷伯菌感染。产ESBLsKp质粒谱多样化,除TEM型与SHV型β-内酰胺酶基因,还含有其他来源基因。Objectives To examine an optimal substrate to screen Klebsiella pneumoniae for production of extendedspectrumβ-lactamases（ESBLs）,to examine the incidence of K.pneumoniae,to examine the drug resistance of K.pneumoniae,and to genotype its drug resistance genes in order to rationally use antibiotics and to establish a control program. Methods Specimens were collected at this Hospital from January 2015-January 2016,and 98 strains of K.pneumoniae were isolated.These strains were screened for production of ESBLs and they were verified to be ESBL-producing strains.The incidence of K.pneumoniae was calculated to compare the results of verification and the results of substrate screening.An optimal substrate to screen for ESBL-producing strains was determined and drug sensitivity testing was performed with 16 antibiotics to analyze the drug resistance of ESBL-producing K.pneumoniae.Drug resistance genes of ESBL-producing K.pneumoniae were amplified with PCR and genotyped.Results Of all the isolated strains of K.pneumoniae,25.51% were ESBL-producing strains.Cefotaxime was the optimal substrate,with a sensitivity as high as100%,followed by ceftriaxone,aztreonam,and cefpodoxime.As a substrate,ceftazidime had the lowest sensitivity（60.42%）and a high miss rate.ESBL-producing strains were resistant to imipenem at a rate of 0%,to amikacin at a rate of20.00%,to cefoperazone/sulbactam at a rate of 33.00%,and to cefoxitin at a rate of 23.00%.ESBL-producing strains had a high level of resistance to the 12 remaining antibiotics.The genotypes ofβ-lactamase from ESBL-producing K.pneumoniaeincluded the TEM,SHV,non-TEM,and non-SHV types. Conclusion K.pneumoniae was sensitive to antibiotics such as cephamycin,imipenem,and complexes withβ-lactamase inhibitors,and these antibiotics can be used to treat an infection with ESBL-producing K.pneumoniae.ESBL-producing K.pneumoniae has a diverse plasmid profile.Types of ESBL-producing K.pneumoniae other than the TEM and SHV types haveβ-lactamase genes as well as genes from other sources

关 键 词：肺炎克雷伯菌 产超广谱Β-内酰胺酶 耐药性 基因型 

分 类 号：R378.996[医药卫生—病原生物学]