摘要
目的了解武汉地区分离的肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)和AmpC酶的发生率、耐药情况及质粒型耐药基因。方法从该地区3家医院的重症监护病房(ICU)分离获得38株肺炎克雷伯菌,采用E-test法进行最低抑菌浓度(MIC)测定;以美国临床实验室标准化委员会(NCCLS)推荐的双纸片协同试验和确证试验检测ESBLs;酶提取物三维试验检测AmpC酶;质粒接合和消除试验检测耐药基因。结果产ESBLs的肺炎克雷伯菌检出率为71.05%(27/38);产AmpC酶的肺炎克雷伯菌检出率为13.16%(5/38);其中同时产ESBLs和AmpC酶的肺炎克雷伯菌检出率为5.26%(2/38)。产酶株对第三代头孢菌素、氨基糖苷类、氟喹诺酮类耐药率均较高,对亚胺培南、厄他培南等碳青霉烯类耐药率最低。通过质粒接合和消除试验,40%(4/10)产ESBLs的肺炎克雷伯菌和20%(1/5)产AmpC酶的肺炎克雷伯菌检测到传播耐药的质粒。结论肺炎克雷伯菌产ESBLs和AmpC酶是其对多种抗菌药物耐药的主要原因,其耐药扩散与细菌质粒的水平传播有关,对这些产酶株的监测和阻止其传播是控制肺炎克雷伯菌感染的重要措施。
Objective To investigate the prevalence of extended-spectrum β-lactamases （ESBLs） and AmpC β-lactamases, antimicrobial resistance and plasmid resistance gene of Klebsiella pneumoniae isolated from Wuhan region. Methods Thirty-eight strains of Klebsiella pneumoniae were isolated from patients in intensive care units of three hospitals in Wuhan region. The minimal inhibitory concentrations（MICs） of the strains were detected by E-test method; ESBLs were studied by double disc synergy and confirmatory tests based on the National Committee for Clinical Laboratory Standard（NCCLS） ; AmpC β-lactamases were studied by three-dimensional methods; drug-resistant gene was studied by plasmid conjugation and elimination experiment. Results ESBLs-producing rate of strains was 71.05% （27/38）, AmpC β-lactamases-producing rate was 13. 16% （5/38）. The rate of both ESBLs and AmpC β-lactamases-producing strains was 5. 26% （2/38）. The resistant rates of ESBLs and AmpC β-lactamases-producing strains were high to third-generation cephalosporins, aminoglycosides and fluoroquinolones, none of the isolates showed resistance to imipenem and etrapenem. 40% （4/10） ESBLs-producing strains and 20% （1/5） AmpC β-lactamases-producing strains were detected the resistant plasmid gene through the plasmid conjugation and elimi- nation experiment. Conclusion ESBLs and AmpC β-lactamases are main causes of antimicrobial resistance of Klebsiella lmeumoniae, the resistant mechanism is relevant to the horizontal transfer of plasmid gene. It is very important to monitor such strains closely and prevent their spread.
出处
《中国感染控制杂志》
CAS
2007年第5期329-332,共4页
Chinese Journal of Infection Control
关键词
超广谱Β-内酰胺酶
AMPC酶
微生物敏感性试验
质粒
extended-spectrum β-lactamases
AmpC β-lactamases
antimicrobial susceptibility test
plasmid
