云南某医院多耐药E. coli 和 K. pneumoni1e分子流行病学分析

目的分析云南某医院Eeoli和五pneumonia菌耐药基因分子流行病学特征。方法全自动微生物分析仪分类鉴定菌株及抗生素敏感试验。扩增并序列分析耐药基因。MIST及PFGE分析菌株遗传变异关系。结果共收集23株Ecoli菌和9株Kpneumonia菌,除了1株XDR彪pneumoniae,其余均为MDR菌。全部菌株对一代、二代头孢霉素,甚至三代头孢霉素CRO耐药。绝大多数菌株对氟化奎林酮类、氨基苷类及磺胺类抗生素耐药。39．1％和69．6％Eeo／i携带厶如嘶和厶‰基因,而44．4％和100．O％尼pneumoniae检测到讹。和Mam基因。胁。均为TEM-1基因型。CTX-M-55及CTX-M-15为该地区优势基因型。所有Kpneumonia菌株携带觚Hv基因,SHV-11为优势型。87．5％Ecoli和77．8％Kpneumoniae菌株携带ISEcpl。91．3％Eeoli和77．8％Kpneumoniae携带intl。44．4％尼pneumoniae携带ISCR1基因。PFGE及MIST研究显示菌株存在明显的遗传多态性。结论云南该医院多重耐药Eeoli和Kpneumonia菌呈高度流行,耐药基因在不同菌株及菌种间快速传播。     

超广谱β-内酰胺酶的检测及耐药性分析

目的 :了解产超广谱 β-内酰胺酶 (ESBL)肺炎克雷白杆菌、大肠埃希氏杆菌、阴沟肠杆菌的发生率、耐药性及耐药特点 ,指导用药。方法 :应用双纸片协同试验法对从临床感染标本中分离出的 2 1 5株革兰氏阴性菌作 ESBL的检测 ,比较亚胺培南等 1 4种抗生素对产 ESBL耐药菌体外抗菌作用。结果 :产 ESBL耐药菌占全部分离菌的 3 4.4% ,其中 ,大肠埃希氏杆菌占 47.3 % ,肺炎克雷白杆菌占 2 8.4% ,阴沟肠杆菌占 2 4.3 %。各类细菌中产 ESBL所占的比例分别是 ,大肠埃希氏杆菌为 3 1 .8% (3 5 /1 1 0 ) ,肺炎克雷白杆菌为 3 9.6% (2 1 /5 3 ) ,阴沟肠杆菌为 3 4.6% (1 8/5 2 )。在产 ESBL菌中 ,有 3株大肠埃希氏杆菌及 2株肺炎克雷白杆菌均同时对头孢噻肟和头孢他啶敏感。亚胺培南对产 ESBL耐药菌均表现出最强的抗菌作用 ;头孢西丁对产 ESBL肺炎克雷白杆菌及大肠埃希氏杆菌呈现出较好的抗菌作用。产 ESBL耐药阴沟肠杆菌对头孢西丁全部耐药 ;氨基糖苷类、氟喹诺酮类及磺胺类药物对产 ESBL肺炎克雷白杆菌、大肠埃希氏杆菌、阴沟肠杆菌有较高的交叉耐药性。结论 :对产 ESBL耐药菌感染不容忽视 ,对此类感染的治疗亚胺培南可作为首选。     

临床分离的肺炎克雷伯菌和大肠埃希菌中超广谱β-内酰胺酶的检测

目的：检测临床分离的临床分离的肺炎克雷伯菌和大肠埃希菌中产超广谱β-内酰胺酶（ESBL）菌株的发生率、耐药性、流行性以及酶的基因型别。方法：采用双纸片法、琼脂稀释法、PCR、脉冲场电泳对1999年复旦大学附属华山医院临床分离的559株肺克雷伯菌和427株大肠埃希菌进行检测。结果：肺炎克雷伯菌和大肠埃希菌中产ESBL菌株的发生率分别为51％和23.6％,产ESBL菌株主要分布于ICU和神经外科病房,对大多数的β-内酰胺酶和非β-内酰胺类抗菌药物耐药;PFGE显示,产ESBL菌株（尤其是产ESBL肺炎克雷伯菌株）在ICU病房中存在同一菌株的克隆传播;PCR检测显示TEM型是最为常见的β-内酰胺酶型别,CTX-M型ESBL亦较为普遍。结论：产ESBL菌株在临床分离的肺炎克雷伯菌和大肠埃希菌中较为普遍,而且为多重耐药菌株,在医院内中存在流行与传播。     

合肥地区产超广谱β-内酰胺酶菌株的分布及药敏分析

目的：了解合肥地区产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌、大肠埃希菌分布及耐药特点。方法：应用纸片扩散法对合肥地区4家较大的综合性医院从临床标本中分离的254株肺炎克雷伯菌和大肠埃希菌进行ESBL的确诊试验。结果：254株大肠埃希菌和肺炎克雷伯菌共检出69株产ESBL菌株（27.2%）,其中,血液感染ESBL检出率为54.5%（6/11）、烧伤科ESBL的检出率为48.6%(18/37）。亚胺硫霉素对产ESBL的大砀埃希菌和肺炎克雷伯菌的敏感率分别为94.5%和80%。头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢西丁对产ESBLs的大肠埃希菌和产ESBLs的肺炎克雷伯菌的敏感率在40%-70%之间,阿米卡星对产ESBL的大肠埃希菌的敏感率为69.2%。结论：ESBL在血液感染的烧伤科标本中的检出率较高。治疗产ESBL菌株引起的感染可首选亚胺硫霉素,其次,选含酶抑制剂的复方制剂和头霉素类。对产ESBL的大肠埃希菌也可选阿米卡星。     

多重耐药肺炎克雷伯菌Kp1503的ESBLs基因型分析

目的:了解广东汕头临床分离的产ESBLs肺炎克雷伯菌Kp1503株的耐药表型与基因亚型。方法:以琼脂稀释法测定Kp1503株对12种抗菌药物的MIC;设计TEM、SHV和CTX-M型全编码基因特异性引物,用聚合酶链反应(PCR)扩增获得其β-内酰胺酶编码基因,分别克隆入pMD18-T载体后测定其核苷酸序列,分析其基因亚型。结果:Kp1503株为多重耐药株,除对亚胺培南和环丙沙星敏感外,对庆大霉素、阿米卡星、四环素、头孢唑林、头孢他啶、头孢噻肟、头孢曲松、头孢吡肟、氨曲南、哌拉西林/三唑巴坦均耐药;其所携带的三种β-内酰胺酶基因序列分别与GenBank中TEM-1、SHV-12及CTX-M-3型编码基因序列的同源性为100%。结论:汕头地区存在同时产SHV-12、CTX-M-3型超广谱β-内酰胺酶及TEM-1型广谱β-内酰胺酶的多重耐药肺炎克雷伯菌。     

Distribution of TEM and SHV beta-lactamase genes among Klebsiella pneumoniae strains isolated from patients in Tehran.

BACKGROUND: There are numerous types of extended spectrum beta-lactamases (ESBLs), of which TEM and SHV are predominant among Klebsiella pneumoniae strains. Nosocomial infections with strains of K. pneumoniae are common in healthcare centers in Iran. However, no information is available on the prevalence of different phenotypes of ESBL strains in Tehran hospitals. MATERIAL/METHODS: To determine the resistance of K. pneumoniae to beta-lactam antibiotics in Tehran hospitals, 145 isolates were tested using the disk diffusion method. The MICs for ceftazidime were also determined using microbroth dilution assay. Isolates showing MIC >/=4 for ceftazidime were subjected to PCR to target the bla(SHV) and bla(TEM) genes and screened for ESBL production by the phenotypic confirmatory method. RESULTS: All strains were susceptible to imipenem. Resistance to ceftazidime and cefotaxime were 31% and 32%, respectively. Fifty-six isolates showed MIC >/=4 microg/ml for ceftazidime, of which 50 were positive for ESBL in the phenotypic confirmatory test. The prevalence of bla(SHV) and bla(TEM) among these isolates was 69.6% (n=39) and 32.1% (n=18), respectively. Resistance to ciprofloxacin was found among 32% of the ESBL strains. CONCLUSIONS: SHV is the dominant enzyme among the ESBL-producing strains of Klebsiella pneumoniae in Iran. The high rate of co-resistance to ceftazidime and ciprofloxacin is a matter of concern and treatment requires further attention to the results of susceptibility.     

抗菌药物的使用方法与超广谱β-内酰胺酶控制之间的关系

目的：探讨哌拉西林／他唑巴坦对减少产超广谱β-内酰胺酶（ESBL）大肠埃希菌或肺炎克雷伯菌定植的价值。方法：研究分为3个月的第Ⅰ阶段（干预前阶段）和6个月的第Ⅱ阶段（干预阶段），在干预前阶段，所有患者均按常规应用抗菌药物治疗各种感染。第Ⅱ阶段前3个月开始抗菌药物干预，所有感染患者推荐用哌拉西林／他唑巴坦治疗（替代3代头孢至少50．0％）。通过直肠拭子培养检查，用双纸片扩散法测定干预前阶段和干预后阶段（最后3个月）患者是否产ESBL的大肠埃希菌或肺炎克雷伯菌。结果：（1）总体上产ESBL的大肠埃希菌或肺炎克雷伯菌的获得率在干预前后从20．0％降至17．0％，但差异无统计学意义。（2）在社区产ESBL的大肠埃希菌或肺炎克雷伯菌呈高的获得率。结论：医院内干预前后产ESBL大肠埃希菌或肺炎克雷伯菌的获得率差异无统计学意义。     

CTX-M-14和CTX-M-24编码基因的检测及其功能表达

目的　了解上海华山医院临床分离大肠埃希菌和肺炎克雷伯菌中产生的超广谱 β 内酰胺酶 (ESBL)的基因型及其流行情况。方法　双纸片法和美国国家临床实验室标准委员会 (NCCLS)表型确定实验检测产ESBL菌株并对产ESBL菌株进行接合实验 ;提取产ESBL菌株及其转移接合子中的质粒 ,进行电泳分析 ;采用琼脂稀释法 ,测定各种菌株对多种抗菌药物的敏感性 ;TEM、SHV、CTX M 1组、CTX M 13组、Toho 1组通用引物检测产ESBL菌株及其转移接合子 ;编码框以外设计引物、聚合酶链反应 (PCR)扩增转移接合子中的CTX M 13组全编码基因 ,克隆入 pHSG398质粒、表达 ,并对PCR产物进行测序 ,分析其基因型 ;对这些产ESBL菌株进行脉冲场电泳 (PFGE)检测。结果　产ESBL菌株对多种 β 内酰胺类和非 β 内酰胺类抗生素耐药 ;产ESBL菌株可通过接合转移方式传递其耐药性 ,转移频率多为 10 -4～ 10 -5,多数非 β 内酰胺类抗生素的耐药性可以和ESBL耐药性发生共转移 ,琼脂糖电泳显示接合子从供体菌得到了一个 >2 3 1kb的质粒 ;转移接合子中仅CTX M 13组通用引物检测为阳性 ;4株转移接合子中CTX M 13组全编码基因序列与CTX M 14编码基因序列的同源性为 10 0 % ,其余 6株转移接合子中CTX M 13组全编码基因序列与CTX M 2 4编码基因序列的同源     

Epidemiological and antibiotic resistant study on extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Zhejiang Province

Objective To investigate the epidemiological status of extended-spectrum β-lactamase (ESBL) producing Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) and the drug resistance profiles of such organisms .Methods A total of 282 clinical isolates of E .coli and 180 of K .pneumoniae were collected from different districts of Zhejiang Province .Inhibitor potentiated broth dilution tests were performed for detecting extended-spectrum β-lactamases .Etests were performed to detect the drug resistance of these strains against nine commonly used antibiotics Results The prevalence of extended-spectrum β-lactamases in E .coli and K .pneumoniae was 34.0% and 38.3%, respectively .The average prevalence of extended-spectrum β-lactamases in E .coli and K .pneumoniae was 35.7% .The resistance prevalence of extended spectrum β-lactamase producing strains to ceftazidime and cefotaxime was 40% and 26% respectively, so were those to cefepime, cefoxitin, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin and ciprofloxacin .All these strains were sensitive to imipenem .Conclusion The results in this study showed that the prevalence of extended-spectrum β-lactamases was high, while extended-spectrum β-lactamase producing strains were resistant to most antimicrobial agents except imipenem .     

肠杆菌科细菌超广谱β-内酰胺酶的检测及药敏分析

目的 :了解超广谱 β 内酰胺酶 (ESBLS)在肠杆菌科细菌中的产生情况及其对部分药物的敏感性 ,以指导临床合理用药。方法 :用双纸片确证试验检测肠杆菌科细菌产ESBLS 的情况 ,用纸片扩散法对 8种抗生素的体外药敏试验结果进行初步分析。结果 :产ESBLS 的肠杆菌科细菌 4 7株 ,其中大肠埃希菌 2 5株、肺炎克雷伯菌 14株、阴沟肠杆菌 5株、催产克雷伯菌 1株、鼻硬结克雷伯菌 1株、液化沙雷菌 1株。在 8种抗生素的体外药敏试验中 ,亚胺培南和美洛培南的敏感率最高 (10 0 % ) ,其次为哌拉西林 /他唑巴坦 (89.4 % )、头孢西丁 (72 .4 % )和头孢替坦 (6 5 .9% )。结论 :产ESBLS 的肠杆菌科细菌主要以大肠埃希菌和肺炎克雷伯菌为主。对于由产ESBLS 株引起的感染 ,亚胺培南和美洛培南可作为首选治疗用药。哌拉西林 /他唑巴坦优于头霉菌素类药物和其他 β -内酰胺酶抑制剂的复合制剂     

Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes

CONTEXT: Infections caused by ceftazidime sodium-resistant gram-negative bacteria that harbor extended-spectrum beta-lactamases (ESBLs) are increasing in frequency in hospitals in the United States. OBJECTIVES: To report a citywide nursing home-centered outbreak of infections caused by ESBL-producing gram-negative bacilli and to describe the clinical and molecular epidemiology of the outbreak. DESIGN: Hospital-based case-control study and a nursing home point-prevalence survey. Molecular epidemiological techniques were applied to resistant strains. SETTINGS: A 400-bed tertiary care hospital and a community nursing home. PATIENTS: Patients who were infected and/or colonized with ceftazidime-resistant Escherichia coli, Klebsiella pneumoniae, or both and controls who were admitted from nursing homes between November 1990 and July 1992. MAIN OUTCOME MEASURES: Clinical and epidemiological factors associated with colonization or infection by ceftazidime-resistant E coli or K pneumoniae; molecular genetic characteristics of plasmid-mediated ceftazidime resistance. RESULTS: Between November 1990 and October 1992, 55 hospital patients infected or colonized with ceftazidime-resistant E coli, K pneumoniae, or both were identified. Of the 35 admitted from 8 nursing homes, 31 harbored the resistant strain on admission. All strains were resistant to ceftazidime, gentamicin, and tobramycin; 96% were resistant to trimethoprim-sulfamethoxazole and 41% to ciprofloxacin hydrochloride. In a case-control study, 24 nursing home patients colonized with resistant strains on hospital admission were compared with 16 nursing home patients who were not colonized on hospital admission; independent risk factors for colonization included poor functional level, presence of a gastrostomy tube or decubitus ulcers, and prior receipt of ciprofloxacin and/or trimethoprim-sulfamethoxazole. In a nursing home point-prevalence survey, 18 of 39 patients were colonized with ceftazidime-resistant E coli; prior receipt of ciprofloxacin or trimethoprim-sulfamethoxazole and presence of a gastrostomy tube were independent predictors of resistance. Plasmid studies on isolates from 20 hospital and nursing home patients revealed that 17 had a common 54-kilobase plasmid, which conferred ceftazidime resistance via the ESBL TEM-10, and mediated resistance to trimethoprim-sulfamethoxazole, gentamicin, and tobramycin; all 20 isolates harbored this ESBL. Molecular fingerprinting showed 7 different strain types of resistant K pneumoniae and E coli distributed among the nursing homes. CONCLUSIONS: Nursing home patients may be an important reservoir of ESBL-containing multiple antibiotic-resistant E coli and K pneumoniae. Widespread dissemination of a predominant antibiotic resistance plasmid has occurred. Use of broad-spectrum oral antibiotics and probably poor infection control practices may facilitate spread of this plasmid-mediated resistance. Nursing homes should monitor and control antibiotic use and regularly survey antibiotic resistance patterns among pathogens.     

汕头地区产超广谱β-内酰胺酶细菌耐药性动态分析

目的：探讨汕头地区革兰阴性杆菌产超广谱β-内酰胺酶（ESBLs）的检出率及耐药性．为指导临床合理使用抗生素提供依据。方法：收集2009年至2011年汕头地区大肠埃希菌1547株和肺炎克雷伯菌837株,采用Vitrk-2全自动分析系统进行ESBLs检测和药敏实验、结果：2009-2011年大肠埃希菌和肺炎克雷伯菌产ESBLs阳性率分别为65．9％、72．9％、71．0％和30．2％、38．4％、33．1％：2010年与2009年产ESBLs菌株分离率比较,差异有统计学意义（P〈0．05）;2009-2011年产ESBLs菌株对多种抗生素具有较高的耐药率;耐药率最低的是碳青霉烯类（亚胺培南和厄他培南）;除碳青霉烯类外,产ESBLs菌株耐药性比较差异无统计学意义（P〉0．05）．产ESBLs菌株对多种抗生素的耐药率明显比不产ESBLs菌株鬲（P〈0．05）结论：汕头地区产ESBLs菌株检出率高;产ESBLs菌株耐药性严重,动态监测对临床     

2004—2008年濮阳市血流感染革兰阴性菌耐药性分析

目的了解濮阳市血流感染革兰阴性菌的分布及主要病原菌对抗生素的耐药情况。方法血培养为梅里埃BacT/Alert3D系统,鉴定菌株采用Vitek2 compact,药敏试验采用微量肉汤稀释法。结果血流感染总阳性率为12.5%。革兰阴性杆菌占阳性标本的43.2%,以大肠埃希菌、肺炎克雷伯菌居多,分别占48.6%、30.0%。大肠埃希菌、肺炎克雷伯菌ESBL的检出率分别为40.8%、43.2%。大肠埃希菌、肺炎克雷伯菌、肠杆菌属AmpC酶检出率分别为2.0%、3.6%、36.7%,对IPM、TZP敏感率分别〉96.7%和83.3%,对PIP、TET的耐药率超过82.9%。铜绿假单胞菌对PIP、CTX、CAZ、GEN的耐药率在31%～50%,对TZP、IPM、CIP的敏感率超过90.9%。结论本地区引起血流感染的革兰阴性菌主要为大肠埃希菌,其次肺炎克雷伯菌。所有主要病原菌特别是肠杆菌属菌株对常用抗生素的耐药现象比较严重。     

Extended spectrum beta-lactamase producing organisms at the University Hospital of the West Indies

Extended spectrum beta-lactamases (ESBL) represent a major group of beta-lactamases that have the ability to inactivate beta-lactam antibiotics containing an oxyimino group such as third generation cephalosporins and monobactams. These enzymes are produced by gram negative organisms, especially members of the Enterobacteriaceae family such as Klebsiella pneumoniae and Escherichia coli. The prevalence of these organisms varies widely internationally, as well as within the same country. This is the first study on ESBL production in K pneumoniae and E coli at the University Hospital of the West Indies, a tertiary care hospital in Jamaica. Two-hundred and sixty-four isolates of K pneumoniae and 300 isolates of E coli were collected over the study period January 2002 to December 2002. Forty-eight (18.2%) K pneumoniae isolates were confirmed to be ESBL producers, while there was no ESBL producing E coli. Infections with ESBL producing organisms can pose a therapeutic challenge, leading to treatment failure if the wrong class of antibiotics is used. With increasing resistance to all classes of antibiotics, there is a narrowing of available treatment options. It is very important that these organisms be monitored and antibiotic policies as well as infection control policies be in place to curtail their spread.     

烧伤病区产超广谱β-内酰胺酶革兰阴性菌分离率及耐药性分析

目的了解我院特别是烧伤病区产超广谱β-内酰胺酶(ESBLs)大肠杆菌、肺炎克雷伯杆菌的流行情况,检测其对常用抗生素的耐药性,为临床治疗和控制ESBLs菌感染及流行提供重要依据.方法通过中心化验室收集我院2000年3月～2001年2月住院患者送检标本中大肠杆菌、肺炎克雷伯杆菌共计258株,应用VITEK自动检测系统(GNS-506药敏分析卡)及双纸片扩散法筛选产ESBLs菌.根据VITEK自动检测系统药敏检测结果分析比较产ESBLs菌和非产ESBLs菌对15种抗生素的敏感性,并对其中38株产ESBLs阳性菌进行12种临床常用抗生素MIC检测.结果 258株入选菌株中产ESBLs阳性率分别为:大肠杆菌18.8%(29/154);肺炎克雷伯杆菌12.5%(13/104).按标本种类分析,分泌物标本培养产ESBLs阳性率最高,为25.5%,与其他标本培养的总阳性率间的差别有显著性意义;按病区分析,烧伤病区产ESBLs阳性率(大肠杆菌38.5%;肺炎克雷伯杆菌25.0%)与其他病区产ESBLs阳性率间差别有显著性意义.药敏结果:产ESBLs的大肠杆菌和肺炎克雷伯杆菌对亚胺培南、美洛培南及头孢西丁的敏感率较高,其次是氨基糖苷类抗生素,产ESBLs的肺炎克雷伯杆菌对哌拉西林/三唑巴坦敏感,对其他抗生素的敏感性下降.结论烧伤病区是产ESBLs菌的高发病区,产ESBLs菌对亚胺培南的敏感率最高,其次是美洛培南、头孢西丁和丁胺卡那.     

广州地区肺炎克雷伯菌产TEM型及SHV型β-内酰胺酶基因表型的研究

目的对广州地区产β-内酰胺酶肺炎克雷伯菌TEM型和SHV型基因型及其分子流行病学进行研究。方法对57株产β-内酰胺酶肺炎克雷伯菌进行blaTEM和blaSHV基因扩增,分别采用变性高效液相色谱技术和测序法对扩增产物进行分析,以明确基因类型。结果57株肺炎克雷伯菌均扩增出blaTEM和blaSHV基因。测序结果表明,TEM-116 ESBL32株,占54．2％;SHV型以SHV-12为主,占33．3％,其次为SHV-11和SHV-2a等,还发现5种新的SHV基因亚型。54株菌株同产TEM和SHV型β-内酰胺酶,占94．7％;其中13．0％同产TEM-116和SHV-12ESBL。结论TEM-116和SHV-12分别是广州地区产β-内酰胺酶肺炎克雷伯菌TEM型及SHV型耐药质粒主要的基因亚型,blawTEM和blaSHV在肺炎克雷伯菌中同产的比例很高,这提示本地区即将或已经面临肺炎克雷伯菌新耐药机制的抵抗和流行,必须加强对产ESBL肺炎克雷伯菌的分子流行病学监测。     

综合性ICU医院内肺炎58例细菌耐药分析

目的　分析ICU医院内肺炎 (NP)菌群的分布及耐药特点 ,探讨临床防治对策。方法　回顾总结ICU1998年 2月～ 2 0 0 3年 2月NP的病原菌谱、耐药性及临床特征。结果　 5 8例NP感染菌 15 9株中G-杆菌占 64 .78%、G+ 球菌占 2 2 .64 %、真菌占 12 .5 8%;G-杆菌以铜绿假单胞菌为主 ( 4 0 .0 8%) ,G+ 球菌主要为金黄色葡萄球菌 ( 90 .0 %) ,MRAS(耐甲氧西林金葡萄 )占金黄色葡萄球菌的 93 .5 %;产ESBL(超广谱 β内酰胺酶 )菌主要为肺炎克雷伯菌和大肠埃希菌 ;除嗜麦芽黄单胞菌外 ,G-杆菌对亚胺培南 /西司他丁、阿米卡星、哌拉西林 /舒巴坦、头孢他啶较敏感 ;产ESBL菌对亚胺培南 /西司他丁、MRSA对万古霉素皆有 10 0 %的敏感率。结论　NP感染以G-杆菌为主 ,对亚胺培南 /西司他丁敏感 ,为降低多重耐药菌和产ESBL菌的产生 ,对呼吸机的相关器械要严格消毒、定期更换 ,并严格控制第三代头孢菌素的使用。     

下呼吸道肺炎克雷伯菌的耐药性研究

目的了解下呼吸道标本中肺炎克雷伯菌耐药特点及产超广谱β内酰胺酶(ESBLs)肺炎克雷伯菌的检出率、基因型特点.方法收集下呼吸道标本中分离出的肺炎克雷伯菌,微量稀释法检测细菌药敏情况,确证试验检测产ESBLs菌,并使用对CTX-M型ESBLs基因特异的引物,pCR扩增产酶菌的ESBLs基因.结果下呼吸道产ESBLs肺炎克雷伯菌占25%.ESBLs阳性细菌对12种抗生素的耐药性远远高于ESBLs阴性菌.35株产ESBLs肺炎克雷伯菌中,16株携带CTX-M型基因.结论该院下呼吸道标本肺炎克雷伯菌中ESBLs的检出率、耐药性高,CTX-M型基因的出现应引起临床医生的足够重视.     

肺炎克雷伯菌β-内酰胺酶基因型分布

目的阐明广州地区肺炎克雷伯菌β-内酰胺酶基因型分布。方法用药敏纸片法对67株耐三代头孢菌素类抗生素的肺炎克雷伯菌进行超广谱β-内酰胺酶(ESBLs)表型筛选,采用PCR检测β-内酰胺酶耐药基因,对部分ESBLs菌株进行脉冲场凝胶电泳(PFGE)。结果 67株菌中有58株菌ESBLs表型阳性,β-内酰胺酶基因检测显示,44株产CTX-M、43株产SHV(其中10株产超广谱的SHV)、14株产OXA-1群、38株产TEM,7株菌产AmpC。产CTX-M的菌株有20株产CTX-M-1群(包括15株产CTX-M-15)和24株产CTX-M-9群(包括14株产CTXM-14)。PFGE结果显示产ESBLs菌株同源性低。结论广州地区耐三代头孢肺炎克雷伯菌以产CTX-M-1群和CTX-M-9群ESBLs为主。