肝病患者医院感染肺炎克雷伯菌产β-内酰胺酶的分类检测及耐药性分析

Antimicrobial Susceptibility,Classification and Distribution of β-Lactamases Produced by Klebsiella pneumoniae from Hepatopathy Patients

目的研究肝病患者医院感染肺炎克雷伯菌(KPN)所产各种β-内酰胺酶(β-lase)分布情况及其耐药性,为临床合理用药提供依据。方法采用多底物纸片法(协同法、拮抗法)、超广谱β-内酰胺酶(ESBLs)确认试验、AmpC酶检测法检测30株肝病患者医院感染KPN所产各种β-lase,采用琼脂扩散法分析其耐药性。结果30株KPN总β-lase检出率为100.0%,其中产青霉素酶24株(80.0%),产广谱酶3株(10.0%),产ESBLs 3株(10.0%),未检出AmpC酶、复合产酶、碳青酶烯酶;肝病患者医院感染KPN对5大类9种抗菌药物较敏感,对环丙沙星、亚胺培南敏感(100.0%),对阿米卡星、庆大霉素较敏感(均90.0%),对氨苄西林耐药率高(100.0%)。结论β-lase检出率高,以青霉素酶、ESBLs为主,未检出AmpC酶、产复合酶、碳青酶烯酶;肝病患者医院感染KPN耐药率不高。

OBJECTIVE To study the antimicrobial susceptibility, classification and distribution of the β-lactamases produced by Klebsiella pneumoniae from hepatopathy patients. METHODS Tests were taken to deteded the β-lactamases produced by 30 strains of K. pneurnoniae from hepatopathy patients, such as synergy test, antagonized test for the inducible AmpC β-lactamases （IABLs）, AmpC β-lactamases （ABLs） phenotype test and extended-spectrum β-lactamases（ESBLs） confirment test,the susceptibility to antimicrobial agents with K-B test. RESULTS All of 30 strains produced the β-lactamases（100.0%）, 24 （80.0%）strains produced penicillinases, 3 （10. 0%） produced broad-spectrum β-lactamases and 3 （10.0 %）strains produced ESBLs alone, all of them did not produce ABLs, and carbapenem-hydrolyzing β-lactamases（CHBLs）. Thirty strains were sensitive to 9 kinds of antimicrobial agents. The rate of resistant to CIP and IMP was none, but the rate of resistant to AMP was high（100. 0%）. CONCLUSIONS The rate of β-lactamases produced by K. pneurnoniae from hepatopathy patients is very high. The main types of β-lactamases are penicillinases and ESBLs, without ABLs and CHBLs. Most of 30 strains are sensitive to 9 kinds of 5 classe antimicrobial agents.