某医院2012-2013年242株肺炎克雷伯菌β-内酰胺酶及整合子耐药基因检测

目的 了解肺炎克雷伯菌主要的β-内酰胺酶和整合子耐药基因型,明确其耐药特性。方法 回顾性分析我院2012年1月至2013年5月临床分离的242株肺炎克雷伯菌药敏结果,聚合酶链反应(PCR)检测其β-内酰胺酶及整合子耐药基因。结果 242株肺炎克雷伯菌对16种抗生素存在不同程度的耐药,其中氨曲南、头孢唑啉、氨苄西林/舒巴坦、头孢曲松和头孢他啶耐药率较高,分别为76.86%、65.70%、63.64%、62.40%和59.92%;亚胺培南、丁胺卡那、厄他培南和哌拉西林/他唑巴坦较为敏感,分别为17.77%、18.88%、18.88%和23.55%。PCR结果显示,ESBLs基因阳性155株,占64.05%,主要为TEM型和SHV型,两者均存在的菌株有114株,占产ESBLs基因菌株的73.55%(114/155)。其次为KPC基因86株,占35.54%;此外AmpC基因43株,占17.77%,全部为DHA型。整合子基因128株,占52.89%,以整合子1(intI-1)为主,共检出120株,占49.59%。结论 我院肺炎克雷伯菌耐药情况严重,主要的耐药基因型为TEM型、SHV型、KPC和intI-1。

Detection of Beta lactamase and integron genes in 242 strains of Klebsiella pneumonia isolated in a hospital from 2012 to 2013

To analyze the genotype and molecular epidemiology of beta lactamase and integron in Klebsiella pneumonia, 242 strains were isolated from the clinic from Jan 2012 to May 2013 in our hospital and their drug susceptibility were retrospectively analyzed. Furthermore, drug-resistant genes for Beta lactamase and integron were detected using polymerase chain reaction (PCR). Results showed that among 242 Klebsiella pneumonia strains, the drug-resistant rates to aztreonam, cefazolin, ampicillin / sulbactam, cefatriaxone and ceftazidime were 76.86%, 65.70%, 63.64%, 62.40%, and 59.92%, respectively, whereas the rates to imipenem, amikacin, ertapenem and piperacillin / tazobactam were only 17.77%, 18.88%, 18.88%, and 23.55%, respectively. And ESBLs gene was confirmed in 155 strains using PCR, accounting for 64.05%. Among which, 114 strains were confirmed to carry with TEM and SHV genotypes, accounting for 73.55% (114/155). Eighty-six strains with KPC gene, accounting for 35.54%, and 43 strains with AmpC gene, accounting for 17.77% and all were DHA type. Integron gene was detected in 128 strains, accounting for 52.89% (128/242); 120 of which were confirmed to carry with integron-1(intI-1), accounting for 49.59% (120/242). There was a high prevalence of drug-resistance of Klebsiella pneumonia in our hospital, and the main drug-resistance genotypes were TEM, SHV, KPC and intI-1.