某三级甲等医院肺炎克雷伯菌耐药性及耐药基因分析

Analysis of Antibiotics Resistance of Klebsiella Pneumoniae and Drug Resistance Gene from a Class Three Grade A Hospital

目的:分析某三级甲等医院连续4年肺炎克雷伯菌的耐药性及耐药基因分布,了解耐药性变化趋势,指导临床合理用药。方法:使用VITEK-32全自动微生物分析仪进行细菌鉴定,用纸片法和最低抑菌浓度(MIC)试验进行药敏分析,用聚合酶链式反应(PCR)对产超广谱β-内酰胺酶(ESBLs)菌株可能携带的主要β-内酰胺酶耐药基因进行检测。结果:在182株临床分离的肺炎克雷伯菌中,痰和咽拭子标本分离率占首位(78.6%);对检测的13种抗菌药物耐药谱分析显示,该菌对哌拉西林耐药率最高,对亚胺培南和美罗培南敏感;产ESBLs菌株的检出率约30%;51%以上的产ESBLs菌株携带至少1种所检测的耐药基因,以blaTEM为主。结论:该院肺炎克雷伯菌分离株耐药范围广、产ESBLs菌检出率高,应引起重视。

OBJECTIVE：To analyze the antibiotic resistance of Klebsiella pneumoniae and distribution of drug resistance gene from a class three grade A hospital in order to investigate the trend of drug resistance change and guide the rational use of antibiotics in the clinic.METHODS：The identification of K.pneumoniae isolates from clinical samples was performed by the VITEK-32 system.The susceptibility test to antimicrobial agents was determined by Disk Diffusion and MIC testing.Detection of β-lactamases gene in the ESBLs-producing isolates was performed using PCR.RESULTS：The highest detection rate of K.pneumoniae was found from sputum and throat swab（78.6%）.As to K.pneumoniae,the resistance ratio to piperacillin was the highest,while imipenem and meropenem was sensitive to bacterial.The detection rate of ESBLs-producing strains was almost 30%.More than 51% of ESBLs-producing strains carried at least a kind of detected β-lactamases genes.Among them,blaTEM gene was the main prevalence gene.CONCLUSION：K.pneumoniae isolates show extensive drug resistance in the hospital with high detection rate of ESBLs-producing strains,which should get more attention in the clinic.