呼吸病房产超广谱β-内酰胺酶肺炎克雷伯菌的耐药性及脉冲场电泳分析

摘要

Objective To collecct clinical isolates of Klebsiella pneumonia ,detect the sensitivity of antibiotics,determine the characterization of ESBLs-producing strains,type the isolates by PFGE and investingate the clinical data for analysis. Methods ESBLs-producing strains were tested by inhibitor potentiated disk diffusion rcommended by CLSI2015. The susceptibility to 26 different kinds of antibiotics were testd by CLSI2015 disk diffusion method. The typing of the gene of strains by PFGE was analyzed. Results Sixty ESBLs strains produced in 115 strains of Klebsiellapneumoniae ,which was 100% sensitive to imipenem and meropenem in antimicrobial susceptibility ,and were basically resistant to Amoxacillin ,ampicillin ,piperacillin and the first to the fourth generation of cephalosporins. The 60 ESBLs-producing Klebsiellapneumoniae gene was divided into 14 types (A ~ N)by PFGE,of which type A was the epidemic strain(35%,21/60). Conclusion The incidence rate of ESBLs-producing strains is high in respiratory ward in severe resistant multiantibioticsThe epidemic caused by homologusKlebsiella pneumonia can happen. PFGE is a stable and reliable method in searching the source of noso-comial infecton and is suitable for surveillance in the homologus nosocomial infecton.%目的 对临床分离产超广谱β-内酰胺酶(ESBLs)的肺炎克雷伯菌的耐药性及同源性进行了研究,探讨其流行特点.方法 收集2014-2015两年的呼吸病房分离的肺炎克雷伯菌115株,按照NC-CLS/CLSI推荐的确诊试验方法进行产ESBLs的菌株筛选.用纸片扩散(K-B)法,用常见的26种抗生素纸片对分离的产ESBLs的肺炎克雷伯菌进行药敏检测(操作及结果判断参照NCCLS/CLSI2015年标准).采用凝胶脉冲场电泳(pulsed-field gel electrophoresis,PFGE)对产ESBLs菌株进行染色体DNA分型.结果115株肺炎克雷伯菌产ESBLs60株,药敏结果产ESBLs 60株菌对亚胺培南,美罗培南敏感率为100%;对氨曲南,氨苄西林,哌拉西林及一到四代头孢菌素类基本均耐药.PFGE将产ESBLs肺炎克雷伯菌基因分14个型(A~N),其中A型为流行菌株(35%,21/60).结论 在呼吸病房中产ESBLs的肺炎克雷伯菌比例较大,耐药性严重,并存在着同源性的肺炎克雷伯菌株的流行,应给予足够的重视.PFGE是一种稳定、精确的基因分型方法,适合用作院内感染的同源性分析.