替加环素和多黏菌素对产KPC酶肺炎克雷伯菌的抗菌效应研究

目的 评价替加环素、多黏菌素对产KPC酶肺炎克雷伯菌的体外抗菌效应研究，指导临床正确选择并合理使用抗菌药物。方法 收集2012—2016年期间分离自温州医科大学附属第三医院临床样本中对碳青霉烯类耐药的肺炎克雷伯菌109株，采用Vitek-2 compact和Vitek MS进行菌种鉴定及药敏试验；采用聚合酶链反应(PCR)法检测菌株的KPC酶耐药基因并采用琼脂稀释法药敏试验分别检测替加环素、多黏菌素等药物的单药最低抑菌浓度(minimal inhibitory concentration, MIC)值。结果 所分离的109株均为产KPC-2肺炎克雷伯菌，经过Vitek-2 compact和KB法试验可知109株肺炎克雷伯菌对阿米卡星的耐药率为82.57%，对亚胺培南、美罗培南等其他药物的耐药率均为100%。琼脂稀释法药敏结果显示109株肺炎克雷伯菌对亚胺培南、美罗培南耐药率均为100%；对阿米卡星耐药率为89%；对替加环素的敏感率为65.1%，29.4%中介；对多黏菌素的敏感率为100%。结论 产KPC-2型肺炎克雷伯菌对多黏菌素和替加环素较为敏感，可作为临床用药参考。

Antimicrobial activity study of tigecycline and polymyxin to KPC-producing Klebsiella pneumoniae

Objective To evaluate the in vitro antibacterial activity of tigecycline and polymyxin against KPC-producing Klebsiella pneumoniae so as to provide guidance for clinical treatment. Methods A total of 109 strains of carbapenem-resistant Klebsiella pneumoniae were isolated from clinical specimens that were collected in the Third Affiliated Hospital of Wenzhou Medical University from 2012 to 2016. The identification and drug susceptibility tests of bacteria were detected by using Vitek-2 compact and Vitek MS. The KPC enzyme genotypes were detected by polymerase-chain-reaction (PCR). The single-agent minimum inhibitory concentration (MIC) of tigecycline, polymyxin etc were detected by agar dilution method . Results KPC-2 target gene band was amplified from all of 109 strains of carbapenem-resistant Klebsiella pneumoniae. Vitek-2 compact and Kirby-Bauer method showed that the amikacin tolerance rate was 82.57%, the imipenem and meropenem tolerance rates were 100%. The agar dilution method indicated that the imipenem and meropenem tolerance rates were 100%, the amikacin tolerance rate was 89%, the polymyxin and tigecycline susceptibility rates were 100% and 65.1%, the intermediation of tigecycline was 29.4%. Conclusion The KPC-2 producing Klebsiella pneumoniae in this area is sensitive to the polycine and diacycline, which can be used as a clinical