肺炎克雷伯菌中超广谱β内酰胺酶和AmpC酶的检测

DETECTION OF EXTENDED Β-LACTAMASES AND AMPC ENZYME FROM KLEBSIELLA PNEUMONIA

[目的]观察对头孢菌素类耐药的肺炎克雷伯菌对抗菌素的敏感性及其产ESBLs和AmpC酶的情况。[方法]利用ATBG-5试条法测定细菌对抗菌素的敏感性,用双纸片协同试验及纸片法确证试验检测ESBLs,用三维试验检测AmpC酶。[结果]从头孢菌素类耐药的肺炎克雷伯菌菌中共检出产ESBLs和AmpC酶分别为90.5%和5.5%,ESBLs和AmpC酶共同存在者为4.6%。产酶菌株对3代头孢菌素高度耐药,对复方磺胺甲噁唑、环丙沙星等有较高的耐药性,对亚胺培南抗生素敏感,加酶抑抑制剂的抗菌素对产AmpC酶菌株无亲和性。[结论]肺炎克雷伯菌存在比较严重的耐药情况,ESBLs和AmpC酶是肺炎克雷伯菌对头孢菌素类耐药耐药的重要机制,实验室应加强对其检测和对抗菌素的耐药性监测,对指导临床合理用药至关重要。

[ Objective] To investigate the sensitivity of Klebsiella pneumoniae which shows drug resistance to cephalosporins to antibiotic drugs and the status of producing extended βspectrum laetamases and AmpC enzyme. [ Methods] ATB G-5 was performed to detect the sensitivity of Klebsiella pneumoniae to antibiotic drugs, and the ESBLs were detected by double disk synergy test and disk confirmatory, as well as the AmpC enzyme was detected by three-dimensional test. [ Results] 90.5% of the ESBLs and 5.5% of the AmpC enzyme were detected from Klebsiella pneumoniae which showed resistant to cefotaxime. 4.6% of the ESBLs and AmpC enzyme were both detected from the Klebsiella pneumoniae. Strains of enzyme-producing bacteria revealed high drug resistance to the third generation cephalospofins, drug resistance to the eiprofloxacin and sulfamethoxazole, and sensitivity to impenem antibiotics. Antibiotic drugs with enzyme inhibitor showed no affinity to the strain of AmpC enzyme. [ Conclusion ] High drug resistance of Klebsiella pneumoniae exists, and the the ESBLs and AmpC enzyme are the main reasons for the drug resistant mechanism of Klebsiella pneumoniae to eephalosporins. Efforts should be taken to monitor drug resistance to antibiotic drugs and its detection in laboratory.It is important to guide the reasonable utilization of drug in clinic.