重症监护病房肺炎克雷伯菌ESBLs检测及耐药性分析

Detection of ESBLs in Klebsiella pneumoniae from intensive care unit and analysis of drug resistance

目的了解江山市人民医院重症监护病房肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的情况及其耐药性分析。方法收集2006年1月至2011年12月该院重症监护病房临床分离的肺炎克雷伯菌418株,采用VITEK-32全自动细菌鉴定仪;药物敏感试验采用K-B纸片扩散法,用双纸片协同试验进行ESBLs检测。采用聚合酶链式反应(PCR)扩增检测细菌产ESBLs的基因分型。结果 418株肺炎克雷伯菌主要来源于痰液标本和中段尿标本等,其中产ESBLs的肺炎克雷伯菌有111株。重症监护病房肺炎克雷伯菌年龄分布以71～80岁年龄组最高,而产ESBLs菌株则以51～60岁年龄组为最高,可达43.1%。产ESBLs菌株对一～三代头孢菌素、氯霉素、大多数氟喹诺酮类抗菌药物耐药率一直很高;对碳青霉烯类抗菌药物总体上有较高的敏感性,但耐药菌也在有所出现。PCR扩增检测ESBLs基因型,该院中CTX-M、SHV、TEM等均占较高比例,提示上述三种耐药基因型在本地区均有分布。结论医院重症监护病房临床分离的肺炎克雷伯菌产ESBLs的比例较高,尤其是泛耐药菌株的不断出现,给临床治疗带来了巨大难题,应引起高度重视,以预防重症监护病房感染的发生和暴发流行。

Objective To investigate the distribution and drug resistance tendency of Extended-Spectrum-lactamase （ESBLs） producing isolates of Klebsiella pneumoniae in intensive care unit （ ICU ） of Jiangshan People＇ s Hospital. Method 418 clinical isolates of K. pneumoniae were collected from ICU, which was identified by VITEK-32 automatic bacte- rial identification instrument. Kirby Bauer was adopted in drug sensitivity test and double disk synergy test was utilized in the test of ESBLs. The genotypes of ESBLs were analyzed by Polymerase Chain Reaction （PCR） amplification. Result A total of 418 K. pneumoniae mainly came from sputum and urine specimens of which 111 strains produced ESBLs. The distribution of K. pneumoniae in ICU was highest in the 71 to 80 age group, while that of the ESBLs producing strains were highest in the 51 to 60 age group （43.1% ）. The ESBLs-producing strains were highly resistant to 1st to 3rd generation of cephalosporins, chlor- amphenicol, and most of fluoroquinolones, while still sensitive to carbapenem. The ESBLs genotypes such as CTX-M, SHV and TEM accounted for a higher proportion, which indicated that the above three resistant genotypes were distributed in our re- gion. Conclusion Higher proportion of ESBLs-producing K. pneumoniae, especially pan-resistant strains, continue to emerge in the ICU of our hospital, which has brought great challenges to the clinical treatment. Therefore, great attention should be paid to prevent the outbreak of ICU acquired infections.