41株ESBL+肺炎克雷伯菌耐药性及质粒介导AmpC酶的基因型分析  

Resistance Analysis and Detection of Plasmid-mediated AmpC Gene of 41 Strains Klebsiella Pneumonia

作　　者：沈伟[1] 肖亚雄[1] 朱波[1] 刘影[1] 龙琴[1] 

机构地区：[1]宜宾市第一人民医院检验科,四川宜宾644000

出　　处：《湖北医药学院学报》2016年第5期479-482,486,共5页Journal of Hubei University of Medicine

摘　　要：目的:研究宜宾市第一人民医院ESBL阳性肺炎克雷伯菌耐药情况,并分析其产质粒介导Amp C酶基因型。方法:采用K-B法进行抗菌药物敏感试验,采用头孢西丁纸片扩散法进行肺炎克雷伯菌Amp C酶表型初筛,改良三维试验对产质粒介导Amp C酶进行确证,采用特异性PCR方法检测质粒介导Amp C酶基因。结果:41株产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌中检测出19株产质粒介导Amp C酶菌株,阳性率46.34%;药敏试验结果显示,单ESBLs阳性与ESBLs和Amp C酶双阳性菌株相比较,后者耐药率明显增高,且呈现出多药耐药性,但对亚胺培南的敏感率为90.00%,多为质粒介导DHA和ACT型Amp C酶。结论:本院ESBLs和产质粒介导Amp C酶双阳性肺炎克雷伯菌检出率高,其质粒介导的Amp C耐药基因为DHA型和ACT型,双阳性肺炎克雷伯菌经验性治疗相关感染首选碳青酶烯类抗菌药物。Objective To study the antibiotic-resistance of klebsiella pneumonia extracted from the First Renmin Hospitai of Yibin and analyze the genotype of plasmid-mediated Amp C. Methods K-B method was used for the antibiotic susceptibility test,the primary screening of klebsiella pneumonia Amp C phenotype was preformed by cefoxitin disk diffusion test,plasmid-mediated Amp C was identified with modified dimensional methods,the gene of plasmid-mediated Amp C was detected by real time fluorescence quantitative PCR. Results In 41 strains of klebsiella pneumonia,19 strains were detected with plasmid-mediated Amp C,the positive rate was 46.34%. The results of antibiotic susceptibility test demonstrated that dual positive strains of ESBLs and Amp C showed higher resistance and multiple drug resistance than those of single ones,but the susceptibility rate to imipenem was 90. 00%,the genotype were mainly DHA and ACT type of plasmid- mediated Amp C.Conclusion The detective rate of dual positive of ESBLs and plasmid-mediated Amp C was high in our hospital,and the drug-resistance genotype was DHA and ACT. Carbopenems would be the first choice for the treatment of dual positive klebsiella pneumonia related infection.

关 键 词：肺炎克雷伯菌 ESBLS AMPC酶 质粒 DHA ACT PCR 

分 类 号：R446.5[医药卫生—诊断学]