肺炎克雷伯菌产ESBLs和AmpC酶的检测及耐药性分析

Detection and analysis of antibiotic resistance of ESBLs-producing and AmpC-producing Klebsiella pneumoniae

目的了解聊城地区临床分离的肺炎克雷伯菌产ESBLs和AmpC酶情况及其耐药性,为临床合理使用抗生素提供依据。方法对156株肺炎克雷伯菌的标本来源进行回顾调查分析,采用Vitek2-compact全自动微生物鉴定系统进行细菌鉴定,药敏试验采用K-B纸片扩散法;同时采用纸片扩散确证法检测ESBLs、采用三维确认试验检测质粒介导AmpC酶。结果检出单产ESBLs 54株(34.6%),单产AmpC酶6株(3.8%),同时产AmpC酶和ESBLs共3株(1.9%)。产ESBLs和AmpC酶菌株对亚胺培南和哌拉西林/他唑巴坦100%敏感,其对抗生素的耐药率除亚胺培南和哌拉西林/他唑巴坦外均高于不产ESBLs和AmpC酶菌株。结论肺炎克雷伯菌产ESBLs和AmpC酶的情况在聊城地区已经出现,产ESBLs和AmpC酶菌株对常用抗生素的耐药率较高,应引起临床注意。

Objective To explore the antibiotic resistance of ESBLs-producing and AmpC-producing Klebsiella Pneumon- iae in Liaocheng area and conduct clinical medication. Methods Aretrospective review was performed to analyze the clinical distribution of 156 isolates of Klebsiella pneumoniae. The strains were identified by using the automatic microor- ganism analyzer vitek2-compact. Bacteria＇ s drug susceptibility was performed by K-B method. Then ESBLs and AmpC were detected by confirmatory test recommended by CLSI/NCCLS and three-dimensional test, respectively. Results In 156 strains of Klebsiella pneumoniae,54 strains（34.6% ） isolates produced ESBLs,6 strains （3.8%） isolates produced AmpC and 3 strains（ 1.9% ） isolates produced both. All isolates of Klebsiella pneumoniae were sensitive to imipenem and piperacillin/tazobactam. Enzyme production strains resistant to antibiotics of the removing rate of imipenem and piperaeil- lin/tazobactam were higher than that of no enzyme producing strain. Conclusion In Liaocheng area ESBLs-producing and AmpC-producing Klebsiella Pneumoniae had emerged. Enzyme producing strains were still highly resistant to many antibiotics ,which should be paid attention in clinic.