三亚地区综合性医院213株产ESBLs肺炎克雷伯菌的临床分布及耐药性基因的检测  

Clinical distribution and drug resistance of 213 strains of ESBLs-producing Klebsiella pneumoniae in general hospitals

作　　者：黎元莉 麦珍 陈海[2] 朱雄[2] 李欢[2] 黎礼达 李康生[1] 

机构地区：[1]广东省汕头大学医学院微生物与免疫学教研室,广东汕头515041 [2]海南省三亚市人民医院检验科,海南三亚572000

出　　处：《国际检验医学杂志》2017年第17期2389-2392,共4页International Journal of Laboratory Medicine

基　　金：海南省三亚市科技创新项目(YW1325;2015YW38)

摘　　要：目的了解三亚市人民医院肺炎克雷伯菌的标本来源及耐药基因情况,为临床合理用药和控制院内感染提供依据。方法从2013年1月至2014年12月各临床送检标本中分离肺炎克雷伯菌,采用Phoenix-100全自动细菌鉴定药敏系统进行药敏试验,按照标准纸片扩散法进行超广谱β-内酰胺酶(ESBLs)表型的筛选和确证,依据当年的美国临床实验室标准化协会(CLSI)标准判读结果,用WHONET 5.6软件对所有数据进行统计分析。用聚合酶链反应(PCR)对213株产ESBLs的肺炎克雷伯菌进行常见的几种的耐药基因进行检测。结果分离并确认213株产ESBLs肺炎克雷伯菌,标本来源主要是痰、呼吸道分泌物,占78.4%;其次是分泌物标本和中段尿,分别占8.92%和5.2%。对头孢噻肟耐药率最高(98.1%);对亚胺培南的耐药率最低(2.86%)。213株产ESBLs肺炎克雷伯菌中有195株能检测到1个或多个耐药基因,分别为CMY,CTX,TEM,SHV,DHA1和KPC,其检出率分别为6.10%、76.53%、59.62%、76.06%、12.21%和2.82%。结论该院肺炎克雷伯菌主要分离自痰、呼吸道分泌物,对常用抗菌药物均产生了一定的耐药性,应进一步了解该院产ESBLs菌株的耐药基因的分布,预防医院感染的发生和多重耐药菌的产生。Objective To investigate the specimen source and gene phenotype of ESBLs in ESBLs-producing Klebsiella pneumonia of people′s hospital of Sanya city,so as to provide basis for clinical use of drugs and nosocomial infection.Methods Klebsiella pneumoniae was isolated from specimens during January 2013 to December 2014,bacteria identification and susceptibility tests were detected by Phoenix-100 system biochemical,supplementary susceptibility test was confined by K-B method according to 2014 CLSI standards.WHONET 5.6was used in the statistical analysis of all data.Results Totally 213 strains Klebsiella pneumoniae were isolated.The detection rates were 78.4% of the respiratory secretions,8.92% and 5.2%respectively of the secretion and the midstream urine.The strains had a certain resistance to commonly used antimicrobial.The highest resistance rate was 98.1% to cefotaxime,and the lowest resistance rate was 2.86% to imipenem.There were 195 in 213ESBLs producing Klebsiella pneumoniae strain were detect one or more drug resistance gene.The detecting rates of 6p-lactamase gene of CMY,CTX,TEM,SHV,DHA1 and KPC were 6.10%,76.53%,59.62%,76.06%,12.21%and 2.82%.Conclusion Klebsiella pneumoniae is mainly isolated from respiratory secretions in the hospital,has a certain resistance to commonly used antimicrobial.We should learn more about the distribution of resistance genes of ESBLs strains,improve the efficiency of the treatment of the infection and to control nosocomial infection and the incidence of multi-drug resistance.

关 键 词：超广谱Β-内酰胺酶 肺炎克雷伯菌 耐药性 医院感染 

分 类 号：R446.5[医药卫生—诊断学]