摘要
目的了解肺炎克雷伯菌临床分离株产超广谱β-内酰胺酶(ESBLs)、头孢菌素酶(AmpC)、金属酶(MBLs)、碳青霉烯酶(KPC)情况,并分析其对19种常见抗菌药物的耐药性。方法 ESBLs和AmpC及MBLs采用三维试验检测,碳青霉烯酶采用改良Hodge试验进行检测,并以K-B法测定19种常见抗菌药物的耐药性。结果 582株肺炎克雷伯菌单产ESBLs 168株,检出率为28.86%;单产AmpC52株,检出率为8.93%;单产KPC 38株,检出率为6.53%;所有菌株中未检出MBLs;同产ESBLs及AmpC43株,检出率为7.39%;同产ESBLs及KPC 12株,检出率为2.06%,同产AmpC及KPC 10株,检出率为1.72%,未发现同产ESBLs、AmpC及KPC 3种酶菌株。单产ESBLs、单产AmpC、同产ESBLs+AmpC肺炎克雷伯菌分离株对亚胺培南、美罗培南培南的耐药率低于3.0%,与非产酶菌株相比,差异无统计学意义(P>0.05);对其余抗生素的耐药率均明显高于非产酶菌株(P<0.01)。另外,同产ESBLs+AmpC肺炎克雷伯菌分离株与单产ESBLs、单产AmpC株相比,对头孢他啶、头孢噻肟、庆大霉素、环丙沙星、左氧氟沙星和复方新诺明等多种抗生素表现为明显升高(P<0.01或P<0.05)。单产碳青霉烯酶株、同产ESBLs及KPC、同产AmpC及KPC菌株对多粘菌素B的耐药率为28.94%～33.33%,其余抗生素的耐药率均高于50.0%;单产KPC株与非产酶菌株相比,对所有抗生素的耐药率均明显升高(P<0.01)。结论肺炎克雷伯菌分离株产生多种β-内酰胺酶,且对常用抗生素呈高度耐药,建议临床医师合理使用抗生素,以免耐药菌株的产生。
Objective To investigate the positive-rates of Extended-Spectrum 13-Lactamases （ ESBLs）, cephalosporinase （AmpC） and Carbapencm in Klebsiella pneumoniae and its resistance rates to 19 common antimicrobial agents. Methods ESBLs, AmpCs and MBLs were detected by three dimensional test and the phenotype of KlebsieUa pneumoniae carhapenemase （KPC） type was detected by the modified Hodge test with Ertapenem indicator, and the resistances to nineteen common antibiotics were detected by K-B method. Results There were 168 strains producing ESBLs only （28.86%） , 52 strains producing AmpC only （8.93%） , and 38 strains producing KPC on- ly （6.53%） ; No strains were found to produce metallo-^-lactamase （MBLs）. There were 43 strains （7.39%） producing both ESBLs and AmpC, 12 strains （2.06%） producing both ESBLs and KPC, and 10 strains （1.72%） producing both AmpC and KPC; No strains were found to produce all the three enzymes. The resistantance rates of the ESBL-producing strains, AmpC-producing strains and ESBL ＋ AmpC-producing strains to imipenem and meropenem were lower than 3.0% , with no significant difference from those of non-enzyme-pro- ducing strains （ P 〉 0.05 ） , while their resistance to the other 17 antibiotics were significantly higher （ P 〈 0.05 ）. In addition, the resist- ance rates of the ESBLs ＋ AmpC producing strains to Ceftazidime, Cefotaxime, gentamicin, ciprofloxacin, levofloxacin and cotrimoxazole were significantly higher than those of the ESBL- or AmpC-producing strains （ P 〈 0.05 ）. The resistance rates of the KPC-, ESBL ＋ KPC- and AmpC ＋ KPC- producing strains to polymyxin B were 28.94% to 33.33% , and to the other 18 antibiotics, higher than 50.0%. And the resistance rates of KPC-producing strains to all the 19 antibiotics were significantly higher, compared with non-enzyme producing strains （ P 〈 O. O1 ）. Conclusions A variety of β-lactamase enzymes were produced in Klebsiella pneumoniae isolates in our hospital, and these strai
出处
《中国微生态学杂志》
CAS
CSCD
2013年第3期325-327,共3页
Chinese Journal of Microecology
关键词
肺炎克雷伯菌
超广谱Β-内酰胺酶
头孢菌素酶
金属酶
碳青霉烯酶
耐药率
Klebsiella pneumoniae
Extended-spectrum β-lactamases
Cephalosporinase
Metallo-β-lactamase
Klebsiella pneumoniae carbapenemase
Drug-resistance
