摘要
目的研究我院产新型β-内酰胺酶肺炎克雷伯菌(KP)的耐药现状,为临床用药提供合理依据。方法614株临床分离的无重复肺炎克雷伯菌,采用NCCLS表型筛选和确证试验检测ESBLs,酶提取物改良三维试验检测AmpC酶株,纸片协同试验检测金属β-内酰胺酶;KB纸片法检测产酶株对11种抗菌药的体外抗菌活性;琼脂二倍稀释法测定9种抗生素对同时产AmpC酶和ESBLs菌株的最低抑菌浓度(MIC)。结果单产ESBLs的检出率为31.8%,单产AmpC酶的检出率为2.6%,同时产ESBLs和AmpC酶的检出率为1.1%,未检出产金属β-内酰胺酶的肺炎克雷伯菌。产ESBLs菌对多种抗生素的耐药性较非产酶株显著升高;产AmpC酶菌对含酶抑制剂抗生素耐药率比产ESBLs菌高;同时产ESBLs和AmpC酶株对多种抗生素耐药;三种酶型均未见亚胺培南耐药株。结论亚胺培南可作为治疗产ES-BLs和AmpC酶肺炎克雷伯菌引起重症感染的首选药物;但产新型β-内酰胺酶菌株的多重耐药和交叉耐药现象十分严重,应高度重视产酶株的监测与控制。
Objective To explore occurrence, distribution and resistance profile of neotype β-lactamases in clinical isolates of Klebsiella pneumoniae for rational use of antibiotics in clinic.Methods A total of nonrepetitive 614 K. pneunoniae were detected by phenotypic confirmatory test based on NCCLS criteria for ESBLs;by three-dimensional extract test for AmpC β-laetamases;by double disk synergy test for metallo-β-1actamase. Susceptibility test to 11 antibiotics was also performed through disk diffusion test. The minimal inhibitory concentrations（MICs） on AmpC β-lactamases and ESBLs producing strains were determined by stabdard agar dilution. Results The incidence of ESBLs-preducing and AmpC producing strains were 31.8% and 2.6% inK. pneumoniae respectively; and only 1.1% in K. pneunoniae were ESBLs and AmpC β-lactamases producing strains.We did not detect the metallo-β-lactamase- producing strains. ESBLs-preducing strains were more resistant than ESBLs negative strains; the resistant rate of AmpC-preducing strains to β-lactamases enzyme inhibitor was higher than ESBLs-preducings. However, all β-lactamase-preducing strains were suspectible to imipenem. Conclusoion The best choices of drugs for treating K. pneumoniae with neotype β-lactamases-preducing strains are limited to imipenem. But the producers posses seriously multi- and cross-drug resistance, which are potentional risk factor of nosocomia breaking out that force intensive surveillance and effective controlling.
出处
《中国实验诊断学》
2007年第5期610-613,共4页
Chinese Journal of Laboratory Diagnosis
