2012~2017年山东省部分地区腹泻病患者肺炎克雷伯菌耐药性分析  

Study on drug resistance of klebsiella pneumoniae among patients with diarrhea in some areas of Shandong province,2012-2017

作　　者：焦红波 张元晴 刘国胜 刘宗东 徐雪华 张新峰[4] 毕秀娟[4] 李静[5] 孟蔚[6] 胡彬[6] JIAO Hong-bo;ZHANG Yuan-qing;LIU Guo-sheng;LIU Zong-dong;XU Xue-hua;ZHANG Xin-feng;BI Xiu-juan;LI Jing;MENG Wei;HU Bin(Lanling County Center for Disease Control and Prevention,Lanling,Shandong,276000,China;不详)

机构地区：[1]兰陵县疾病预防控制中心,山东兰陵276000 [2]济南科佳医学检验有限公司,山东济南250001 [3]莱州市疾病预防控制中心,山东莱州261400 [4]泰安市疾病预防控制中心,山东泰安271000 [5]泰安市泰山区疾病预防控制中心,山东泰安271000 [6]山东省疾病预防控制中心,山东济南250014

出　　处：《预防医学论坛》2021年第6期420-422,427,共4页Preventive Medicine Tribune

基　　金：国家科技重大专项(项目编号:2018ZX10713001-002;2018ZX10733402-94);山东省医药卫生科技发展计划项目(项目编号:2017WS455);山东预防医学会智飞疾病预防控制技术研究基金项目(项目编号:LYH2017-03)。

摘　　要：目的了解山东省部分地区腹泻患者粪便标本中分离的肺炎克雷伯菌(KPN)的耐药情况,为肺炎克雷伯菌的预防控制以及临床治疗提供参考。方法收集2012~2017年泰安市、莱州各哨点医院腹泻病患者粪便标本,同一患者剔除相同部位的重复分离菌株后,一共244株被纳入本研究。对分离到的肺炎克雷伯菌进行系统生化鉴定,采用微量肉汤稀释法进行药物敏感性试验,采用双纸片协同试验进行超广谱β-内酰胺酶(ESBLs)检测。结果耐药率最高的是磺胺异恶唑(88.93%),其次为氨苄西林(86.48%),并且存在严重的多重耐药现象。耐药谱为:磺胺异恶唑-氨苄西林-链霉素-氯霉素素-四环素,对亚胺培南、头孢西丁和头孢吡肟敏感性较高,分别为和91.39%、82.38%和81.15%。检测ESBLs阳性菌株为13.52%。结论山东省部分地区腹泻患者中肺炎克雷伯菌的耐药率较高。Objective To understand the drug-resistant phenotypes and drug-resistant genotypes of klebsiella pneumoniae(KPN) isolated from fecal specimens from patients with diarrhea in some areas of Shandong province, so as to provide reference for KPN prevention and control and clinical treatment. Methods Collection of fecal specimens from patients with diarrhoea in hospitals in Taian city and Laizhou city during 2012-2017.A total of 244 strains were included in the same study after the same patient was removed from the duplicated strains in the same site.Systematic biochemical identification of isolated KPN.Drug susceptibility test using trace broth dilution.Detection of carbapenem phenotypic resistance using CHRO Magar KPC medium.And PCR was used to detect common carbapenem antibiotic resistance genes(blaKPC,blaNDM,blaIMP,blaVIM,blaOXA-48) and whole genome sequencing analysis. Results The highest rate of drug resistance was sulfisoxazole(88.93%),followed by ampicillin(86.48%),and there was a serious multidrug resistance phenomenon.The drug resistance spectrum was: sulfisoxazole-ampicillin-streptomycin-chloramphenicol-tetracycline.And sensitivity to imipenem,cefoxitin,and cefepime was high, with 91.39%,82.38%,and 81.15%,respectively.The ESBL positive strain was detected as 13.52%. Conclusion The drug resistance of KPN in patients with diarrhea in some area of Shandong province is relatively serious.

关 键 词：肺炎克雷伯菌 耐药性检测 超广谱Β-内酰胺酶 

分 类 号：R378.996[医药卫生—病原生物学]