产超广谱β-内酰胺酶和头孢菌素酶肺炎克雷伯菌的分布及耐药特征分析  

Distribution and drug resistance of extended-spectrum β-lactamases-and cephalosporinases-producing Klebsiella pneumoniae

作　　者：王晓丽[1] 葛亮[1] 李兴华[1] 

机构地区：[1]新疆医科大学第二附属医院检验科,新疆乌鲁木齐830028

出　　处：《中华医院感染学杂志》2018年第1期5-9,共5页Chinese Journal of Nosocomiology

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016D01C195)

摘　　要：目的了解医院产超广谱β-内酰胺酶(ESBLs)和头孢菌素(AmpC)酶肺炎克雷伯菌的分布及耐药性,为临床合理使用抗菌药物提供依据。方法对医院2011年1月-2016年12月临床送检各类标本进行培养,分析产ESBLs与AmpC酶肺炎克雷伯菌的检出率,药敏试验采用K-B扩散法;双纸片增效法检测ESBLs;头孢西丁三维实验法检测AmpC酶;采用法国生物梅里埃公司VITEK-2-compact GN卡进行细菌鉴定。结果共分离肺炎克雷伯菌2 124株,主要来自下呼吸道及气管抽吸物,占60.64%;六年间共检出952株产酶菌,检出率为44.82%,其中单产ESBLs750株,占78.78%,单产AmpC酶123株,占12.92%,同产ESBLs+AmpC酶79株,占8.30%;产酶株主要集中在ICU及康复科,检出率分别为56.07%及55.77%;>60岁年龄组产酶检出率最高,为55.52%,与其他年龄组比较,差异有统计学意义(χ2=174.468,P<0.01);产酶株与非产酶株对相同抗菌药物的耐药率,存在差异(P<0.01);产酶株中出现了对碳青霉烯类抗菌药物耐药菌;除外头孢唑林、头孢呋辛、头孢吡肟、左氧氟沙星、环丙沙星、磺胺甲噁唑/甲氧苄啶及米诺环素等7种抗菌药物,单产AmpC酶肺炎克雷伯菌对其余15种抗菌药物的耐药率相比于单产ESBLs要高;除头孢唑林、头孢呋辛及阿莫西林/克拉维酸外,同产ESBLs+AmpC酶的肺炎克雷伯菌对其余19种抗菌药物的耐药率相比于单产AmpC酶及单产ESBLs更高。结论产酶的肺炎克雷伯菌耐药严重,临床应合理使用抗菌药物以降低耐药率。OBJECTIVE To investigate the distribution and drug resistance of extended-spectrumβ-1actamases （ES- BLs）- and cephalosporinases （AmpC）-producing Klebsiella pneumoniae so as to provide guidance for reasonable＇ clinical use of antibiotics.METHODS The specimens that were submitted from clinical departments from Jan 2011 to Dec 2016 were cultured, the isolation rates of ESBLs- and AmpC-producing K.pneumoniae were analyzed, the drug susceptibility testing was carried out by using K-B method, the ESBLs were detected by means of double-disk synergistic test, the AmpC was detected with the use of cefoxitin three-dimensinal experiment, and the bacterial identification was performed by using VITEK-2-compact GN card of BioMrieux, France. RESULTS A total of 2124 strains of K.pneumoniae were isolated, of which 60.64% were isolated from lower respiratory tract secre- tions and tracheal aspirates.Totally 952 strains of enzymes-producing bacteria were isolated in the 6 years, with the isolation rate 44.82%, including 750 （78.78 %） strains of ESBLs-producing K. pneumoniae, 123 （12.92 %） strains of AmpC-producing K.pneumoniae and 79 （8.30 %） strains of ESBLs plus AmpC-producing K.pneumoni- ae .The isolation rate of the enzymes-producing strains was 56.07 % in ICU, 55.77 % in rehabilitation department.The isolation rate of the enzymes-producing strains was the highest （55.52 %） in the more than 60-year old group, as compared with other age groups, there was significant difference （x2 = 174.468,P^0.01）.There was significant difference in the resistance to the same antibiotic between the enzymes-producing strains and the non-enzymes-pro- ducing strains （P〈0.01）.The carbapenems-resistant strains have emerged among the enzymes-producing strains. The drug resistance rate of the AmpC-producing K.pneumoniae strains was higher than that of the ESBLs-produ- cing strains to the 15 kinds of antibiotics except for 7 kinds of antibiotics including cefazolin, cefuroxime, cefepime, levofloxacin, ciprofloxacin,

关 键 词：肺炎克雷伯菌 ESBLS AMPC 耐药性 

分 类 号：R378.996[医药卫生—病原生物学]