儿童下呼吸道感染肺炎克雷伯菌耐药性及dha基因研究

Study on the drug resistance and dha gene in Klebsiella pneumoniae isolated from pediatric patients with lower respiratory tract infection

目的了解儿童下呼吸道感染肺炎克雷伯菌的耐药性及其DHA基因型情况,为临床诊疗提供依据。方法对湖南省儿童医院2010年1月-2012年1月下呼吸道感染住院患儿,常规进行深部痰培养,用全自动微生物分析仪VITEK2compact进行鉴定和药敏试验,并进行DHA基因检测。结果 31 568份合格下呼吸道感染患儿痰标本,共分离出1 864株肺炎克雷伯菌,检出率6.0%。其中的23株肺炎克雷伯菌对氨苄西林、头孢一二三代(包括含酶抑制剂的抗菌药物)、氨曲南等耐药率较高,对头孢吡肟、亚胺培南、环丙沙星敏感率较高。基因检测显示:肺炎克雷伯菌有DHA型AmpC酶。结论肺炎克雷伯菌是儿童下呼吸道感染的重要病原菌。其中对于产DHA酶菌株头孢吡肟是首选药物,重症患儿可用亚胺培南。加强抗菌药物使用的控制,防止更多的耐药基因在菌种中传播。

Objective To investigate the drug resistance of Klebsiella pneumoniae and the presence of dha gene among children with lower respiratory tract infection,and to provide a basis for clinical diagnosis and treatment.Methods We performed routine sputum cultures among lower respiratory tract infection children admitted to Children＇ s Hospital of Hunan from January 2010 to January 2012.Bacterial identification and drug susceptibility testing were conducted by using an automatic analyzer （VITEK2 compact）.And then the dha gene test was performed.Results Totally 1,864 strains of K.pneumoniae were isolated from 31,568 eligible sputum samples,with the detection rate of 6.0%.Among the separated strains,23 strains of K.pneumoniae were highly resistant to ampicillin,the first-,second-and third-generation cepbalospofins （included antimicrobial agents containing enzyme inhibitors）,and aztreonam,but highly sensitive to cefepime,imipenem and ciprofloxacin.The gene test showed that K.pneumoniae produced plasmid-mediated AmpC β-lactamases.Conclusions K.pneumoniae is the key pathogenic bacterium causing lower respiratory tract infection in children.Cefepime should be considered firstly to medication of K.pneumoniae producing AmpC β-lactamases,and imipenem can be used in the severe cases.It is necessary to strengthen the control of antibiotics and reduce the resistance gene transmission.