刘立新, 章华萍. 重症监护病房患者医院感染产-内酰胺酶和头孢菌素酶的肺炎克雷伯菌耐药性及基因型研究[J]. 疾病监测, 2013, 28(10): 857-860. DOI: 10.3784/j.issn.1003-9961.2013.10.018
引用本文: 刘立新, 章华萍. 重症监护病房患者医院感染产-内酰胺酶和头孢菌素酶的肺炎克雷伯菌耐药性及基因型研究[J]. 疾病监测, 2013, 28(10): 857-860. DOI: 10.3784/j.issn.1003-9961.2013.10.018
LIU Li-xin, ZHANG Hua-ping. Drug resistance and genotype of -lactamases-producing Klebsiella pneumoniae in ICU patients with nosocomial infection[J]. Disease Surveillance, 2013, 28(10): 857-860. DOI: 10.3784/j.issn.1003-9961.2013.10.018
Citation: LIU Li-xin, ZHANG Hua-ping. Drug resistance and genotype of -lactamases-producing Klebsiella pneumoniae in ICU patients with nosocomial infection[J]. Disease Surveillance, 2013, 28(10): 857-860. DOI: 10.3784/j.issn.1003-9961.2013.10.018

重症监护病房患者医院感染产-内酰胺酶和头孢菌素酶的肺炎克雷伯菌耐药性及基因型研究

Drug resistance and genotype of -lactamases-producing Klebsiella pneumoniae in ICU patients with nosocomial infection

  • 摘要: 目的 探讨重症监护病房(ICU)患者医院感染产-内酰胺酶(ESBLs)和头孢菌素酶(AmpC酶)的肺炎克雷伯菌耐药基因型及对常用抗菌药物的耐药特性,为临床合理用药提供参考依据。 方法 细菌鉴定采用VITEK-60型全自动微生物鉴定仪鉴定;ESBLs和药敏试验K-B纸片法按CLSI推荐的方法;产AmpC酶菌株筛选采用头孢西丁纸片扩散法;产AmpC酶菌株确证试验采用三维试验;通过酶粗提物头孢西丁三维试验、PCR测序等实验分析该菌株的基因型。 结果 97株肺炎克雷伯菌ESBLs和AmpC酶总检出率分别为31.96%和13.40%,其中,单产AmpC酶、同产AmpC酶+ESBLs及单产ESBLs菌株检出率分别为7.22%、6.19%和25.77%;13株产AmpC酶阳性菌株的耐药基因型均为DHA-1;产酶菌株对抗菌药物耐药率明显高于非产酶株。同产AmpC酶+ESBLs菌株耐药现象更为严重。 结论 ICU患者肺炎克雷伯菌产AmpC酶和ESBLs菌株检出率较高,AmpC酶基因型均为DHA-1型,产AmpC酶和ESBLs菌株对多种抗菌药物呈耐药状态。

     

    Abstract: Objective To explore the genotype and the drug resistance characteristics of ESBLs and AmpC-lactamase producing Klebsiella pneumoniae in ICU patients with nosocomial infection and provide evidence for the clinical medication. Methods The isolates were identified with VITEK 60 System; the ESBLs detection and drug sensitivity test (Kirby-Bauer method) were conducted according to the standards recommend by CLSI; the suspected AmpC-lactamase producing strains were screened with cefoxitin disk diffusion test. the genotypes were analyzed with cefoxitin three-dimensional test and PCR sequencing. Results Of the 97 isolates, 31.96% were ESBLs positive, 13.40% were AmpC-lactamase positive. Among them, only AmpC-lactamase producing isolates accounted for 7.22%; both AmpC-lactamase and ESBLs producing isolated accounted for 6.19%; only ESBLs producing isolates accounted for 25.77%. The drug resistant genes of all 13 AmpC-lactamase positive strains belonged to genotype DHA-1. ESBLs producing strains were resistant to more drugs than the non ESBLs producing strains. Both AmpC-lactamase and ESBLs producing isolates had more serious drug resistance. Conclusion The detection rates of AmpC-lactamase and ESBLs producing Klebsiella pneumoniae were high in ICU patients. All the AmpC-lactamase belonged to genotype DHA-1 and both AmpC-lactamase and ESBLs producing Klebsiella pneumoniae strains were multi-drug resistant.

     

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