产ESBLs肺炎克雷伯菌的整合子介导耐药的研究

目的研究产ESBLs肺炎克雷伯菌临床分离株的耐药性、整合子的分布以及ESBLs的基因表型，探讨整合子介导的耐药机制在产ESBLs菌耐药性中的作用。方法对368株产EsBLs肺炎克雷伯菌进行PCR检测，分析其整合子结构基因以及ESBLs基因（blaT旷bla…和6肠CTXM）。结果I类整合子、6肠sH。、6f口T旷6f口cTx_M的检测率分别为54．35％、40．93％、42．75％、44．82％，未检测到II、III类整合子阳性菌；携带6肠。。基因的菌株检测到I类整合子的比例显著高于携带6肠。~NSDbtaCTXM基因的菌株（P〈O．01）；环丙沙星、头孢吡肟、左旋氧氟沙星和哌拉西林外，整合子阳性和整合子阴性产ESBLs肺炎克雷伯菌株对其他8种抗生素的耐药率不同（P〈O．05）。结论我院产ESBLs肺炎克雷伯菌中整合子以I类整合子为主，II类和III类整合子较少；我院ESBLs肺炎克雷伯菌b／a…．．比例略高；I类整合子参与产ESBLs肺炎克雷伯菌耐药性的形成。

Study on the Drug Resistance Induced by Integrin in ESBLs-producing Klebsiella pneumoniae

Objective To study the drug resistance, integron distribution and gene phenotype of ESBLs in ESBLs-producing Klebsiella pneumonia, and explore the effect of integron to the drug resistance in ESBLs-producing Klebsiella pneumonia. Methods The gene phenotype （blaTEM, blasrtv and blacTx.M） and integron distribution in ESBLs- producing Klebsiella pneumonia were analyzed by PCR. Results The positive rates of int I, SHV, TEM, CTX-M were 54.35%, 40.93%, 42.75%, 44.82%, no strain with integron of Class II and III; The proportion of strains with blasHv was much higher than that with blareM and blaa~M. The drug resistence to the other 8 antibiotic was different in ESBLs- producing Klebsiella pneumonia with integron compared with that in ESBLs-producing Klebsiella pneumonia without integron, except ciprofloxacin, cefepime, amikacin, levofloxacin and piperacillin （P 〈 0.01）. Conclusion The integron in ESBLs-producing Klebsiella pneumonia separated from our hospital is mostly class I, and class II and III is much less; The gene phenotype proportion of ESBLs-producing Klebsiella pneumonia separated from our hospital is a little higher; The integron of class I involes the formation of drug resistence in ESBLs-producing Klebsiella pneumonia.