新生儿医院产超广谱β-内酰胺酶肺炎克雷伯菌感染分离株耐药性及基因类型检测

目的 了解新生儿医院感染产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌分离株的耐药状况及β-内酰胺酶编码基因TEM、SHV、OXA、PER、GES、VEB、CTX型存在状况。方法 将我院2004年7月新生儿病房感染的14株肺炎克雷伯菌用全自动微生物鉴定和药敏分析配套卡进行抗生素敏感性检测和ESBLs检测，并采用聚合酶链反应及序列分析方法分析菌株内的超广谱β-内酰胺酶基因型。结果 14株产ESBLs的肺炎克雷伯菌药敏结果一致，氨苄西林、头孢曲松、头孢唑林、头孢他啶均耐药对阿莫西林／克拉维酸、哌拉西林／三唑巴坦也耐药，对亚胺培南敏感。均检出blacTX-M和blaTEM基因，未检出blasm,、扰noxA、blaPER、扰nGES和blaVEB基因。对blarm和blacTX-M基因扩增产物测序，经BLAST程序分析基因为TEM-1和CTX-M-3型。结论 本院感染流行的ESBLs肺炎克雷伯菌耐第三代头孢菌素和耐酶抑制剂，基因类型为TEM-1和CTX-M-3。新生儿属于ESBLs的高危人群，新生儿病房产超广谱β-内酰胺酶菌感染应引起各方关注。

Investigation of the antibiotics resistance and resistant-genotype of ESBLs producing Klebsiella pneumoniae isolates from newborns

Objective To investigate the antibiotics resistance of ESBLs producing Klebsiella pneumoniae(KPN)which were isolated from newborns and the genotype existence of TEM,SHV,OXA,PER,GES,VEB and CTX.Methods The antimicrobial susceptibility and ESBLs detection of fourteen KPN isolates from newborns in the Materity and Children Health Hospital of Changzhou,in July,2004 were performed.The genotype of ESBLs from KPN were identified by polymerase chain reaction(PCR).Results Total of 14 KPN producing ESBLs were resistant to ampicillin,ceftriaxone,cefazolin,ceftazidime,amoxicillin/clavulanic acid and piperacillin/tazobactam,while sensitive to imipenem.All 14 KPN carried blaCTX-M gene and blaTEM gene,whereas blaSHV,blaOXA,blaPER,blaGES and blaVEB genes were not detected.blaCTX-M gene and blaTEM gene were identified as blaTEM-1 and blaCTX-M-3.Conclusion The KPN isolated from newborns were resistant to the third generation cephalosporins and enzyme inhibitors,and the genotype were TEM-1 and CTX-M-3.As newborns are a high-risk group,it should be pay more attention to keep them from the ESBLs-producing KPN epidemic outbreak.