摘要
目的调查该院临床分离肺炎克雷伯菌产质粒AmpC酶表型和基因型携带情况及其对常用抗生素的耐药性,为临床合理用药提供参考。方法采用Vitek2-compact全自动细菌鉴定药敏系统对临床分离菌株进行鉴定及药物敏感试验,采用头孢西丁三维试验检测AmpC酶表型,采用多重PCR方法检测AmpC基因并经DNA测序确定其基因型别。结果 2010年7月至2011年6月共分离到116株肺炎克雷伯菌,产AmpC酶肺炎克雷伯菌占18.1%(21/116)。产AmpC酶肺炎克雷伯菌多重耐药情况严重,对氨基糖甙类、喹诺酮类及大多数头孢菌素类抗菌药物的耐药率在57.1%～100%,对加酶抑制剂复合药氨苄西林/舒巴坦、阿莫西林/克拉维酸、头孢哌酮/舒巴坦及哌拉西林/他唑巴坦的耐药率分别为90.5%、85.7%、42.9%、38.1%,所有菌株对碳青霉烯类抗生素亚安培南和美罗培南仍全部敏感。产AmpC酶菌株对头孢西丁、第3代头孢菌素及氨苄西林/舒巴坦、阿莫西林/克拉维酸等抗生素的耐药率明显高于不产酶株(P<0.05)。21株产酶菌株均携带DHA-1型AmpC酶基因。结论该院肺炎克雷伯菌产AmpC酶株检出率较高,产酶菌株多重耐药情况严重。临床应根据药敏结果合理选用抗菌药物,以减少耐药菌株的产生。
Objective To investigate the prevalence and genotypes of AmpC beta-lactamase produced by Klebsiella pneumoniae in our hospital,and analyze its antibiotic resistance.Methods The identification and antibiotics susceptibility of isolates were determined by the Vitek2-compact automatic microbial identification system.AmpC beta-lactamases was detected by three-dimensional extract test.Genotypes of AmpC beta-lactamases were determined by multiplex PCR and DNA sequencing.Results A total of 116 isolates were collected from Jul 2010 to Jun 2011.The AmpC beta-lactamase were detected in 21 isolates,accounting for 18.1%.The resistants of AmpC beta-lactamases-producing isolates to third-generation cephalosporins,aminoglycosides,and quinolones antibiotics were 57.1%-100%.The resistances to ampicillin/sulbactam,amoxicillin/clavulanate,cefoperazone/sulbactam,and piperacillin/tazobactam were 90.5%,85.7%,42.9%,38.1%,respectively.All isolates were sensitive to imipenem and meropenem.The resistances of AmpC beta-lactamase positive strains to drugs such as cefoxitin,third-generation cephalosporins,ampicillin/sulbactam,amoxicillin/clavulanate were significantly higher than that of AmpC beta-lactamase negative strains.The genotypes of AmpC beta-lactamases in all 21 isolates were DHA-1 type.Conclusion The multiple drug resistance of AmpC producing K.pneumoniae in our hospital was serious and the ratio of AmpC beta-lactamases producing strains was higher.The antibiotic for the treatment of infection caused by AmpC producing K.pneumoniae should be used according to antibiotic susceptibility test results.
出处
《重庆医学》
CAS
CSCD
北大核心
2012年第24期2510-2512,共3页
Chongqing medicine
