肺炎克雷伯杆菌对氨基糖苷类耐药机制的研究

目的了解肺炎克雷伯杆菌对氨基糖苷类药物的耐药情况,同时进行基因分型,确立耐药基因的位点和种类,进一步研究不同基因型对庆大霉素、阿米卡星、奈替米星、链霉素、妥布霉素的耐药情况以及产超广谱β-内酰胺酶与非产超广谱β-内酰胺酶同基因型的关系。方法收集浙江省人民医院检验医学中心2007年2月至2007年8月分离鉴定菌株31株,采用Kirby-Bauer法测定肺炎克雷伯杆菌对庆大霉素、阿米卡星、奈替米星、链霉素、妥布霉素的敏感性,并采用聚合酶链反应(PCR)及电泳测定技术分析氨基糖苷类修饰酶基因型。结果从浙江省人民医院分离到的31株肺炎克雷伯杆菌对庆大霉素、奈替米星、链霉素的耐药率分别为58.1%、6.5%、61.3%,阿米卡星和妥布霉素都未发生耐药;含一种基因型的有6株,两种基因型的有10株,三种基因型的有8株,四种基因型的有3株;产ESBLs有4株,其中含aac(3)-Ⅱ、aac(6″)-Ⅱ产ESBLs的百分率达75%。结论必须加强对细菌耐药性变迁的动态监测,更好地指导临床合理用药。

The research of aminoglycosides resistance mechanism of Klebsiella pneumoniae

Objective To investigate the drug resistance status of Klebsiella pneumoniae to aminoglycosides,perform genotyping to identify the locus and types of drug resistance gene,and further to understand the drug resistance of different genotypes to gentamycin,amikacin,netilmicin,streptomycin and tobramycin,as well as the relationship between ESBLs production,ESBLs non-production and genotypes.Methods Thirty-one cases of isolates from Feb 2007 to Aug 2007 in Zhejiang Provincial Hopsital were involued in the investigation.Kirby-Bauer method was employed to detect the sensitivity of Klebsiella pneumoniae to the above antibiotics,PCR and electrophoresis were applied to analyzing aminoglycosides modification enzyme genotypes.Results The resistance rate of 31 strains of Klebsiella pneumoniae to gentamycin,netilimicin and streptomycin was 58.1%,6.5% and 61.3% respectively.Amikacin and tobramycin were sensitive antibiotics.6 strains contained a genotype,while 10 strains contained 2 kind of genotypes,8 strain 3 kind.4 strains of Klebsuella pneumoiae produced ESBLs,among which aac(3)-Ⅱ and aa(6")-comtained strains producing ESBLs accounted for 75%.Conclusion Dynamic monitoring of drug resistance status should be emphasized to guide clinical rational administration.