产ESBLs肺炎克雷伯菌的耐药基因研究

The Study on ESBLs Gene of Klebsiella pneumonia

目的研究产ESBLs肺炎克雷伯菌临床分离株的耐药性以及ESBLs的基因表型。方法对500株产ESBLs肺炎克雷伯菌的可疑临床分离株进行ESBLs确证,并采用琼脂稀释法进行药敏试验;采用聚合酶链(PCR)反应分析368株产ESBLs肺炎克雷伯菌株的ESBLs基因(bla TEM、bla SHV和bla CTX-M),分析产ESBLs肺炎克雷伯菌的耐药性及ESBLs的基因表型情况。结果产ESBLs肺炎克雷伯菌筛选试验初步筛出500株,通过进一步确认试验368(77.2%)株确认为出产ESBLs菌;368株产ESBLs肺炎克雷伯菌株中有158株(40.93%)检测到bla SHV,165株(42.75%)检测到bla TEM,173株(44.82%)检测到bla CTX-M;除阿米卡星、加替沙星、环丙沙星、左旋氧氟沙星外,产ESBLs肺炎克雷伯菌株和不产ESBLs肺炎克雷伯菌株对其他8种抗生素的耐药率不同(P<0.01);结论产ESBLs肺炎克雷伯菌其耐药性高于非产ESBLs肺炎克雷伯菌;我院ESBLs肺炎克雷伯菌bla CTX-M比例略高。

Objective To study the drug resistance and gene phenotype of ESBLs in ESBLs-producing Klebsiella pneumonia. Methods 500 strain of suspicious ESBLs-producing Klebsiella pneumonia were confirmed, and received drug sensitive test by method of agar dilution. The gene phenotype （blaTEM, blasHv and blaCTX-M） distribution in ESBLs-producing Klebsiella pneumonia were analyzed by PCR. Drug resistance gene phenotype of ESBLs in ESBLs-producing Klebsiella pneumonia were analyzed. Results There were 368 strains （77.2%） in the 500 strain suspicious ESBLs-producing Klebsiella pneumonia after confirmed; There were 158 strains （40.93%） with gene of blasHv, 165 strains （42.75%） with blaTEM, and 173 strains （44.82%） with gene of blaCTX-M; The drug resistence to the other 8 antibiotic was different in ESBLs-producing Klebsiella pneumonia compared with that in non-ESBLs-producing Klebsiella pneumonia except amikacin, gatifloxacin, ciprofloxacin and levofloxacin （P 〈 0.01）. Conclusion The drug resistence in ESBLs-producing Klebsiella pneumonia is high than that in non-ESBLs-producing Klebsiella pneumonia; The gene phenotype proportion of ESBLs-producing Klebsiella pneumonia separated from our hospital is a little higher.